Ugh, a stitch: What they are, who gets them and 4 strategies to fight them off!

Most runners have experienced the dreaded sharp pain that is characteristic of the side stitch.

In fact, 70% of runners will experience at least one in the next six months. 

While they’re incredibly common, there’s still a lot of mystery about them. Even the experts have limited understanding of what causes them and how to best avoid and manage them. Compound that with all kinds of myths out there and you're likely to hear of a different hack from each person you ask.

So while there is still much to be learned, we’re here to help you navigate what we do know. And the good news is, we do know a lot!

What is a stitch?

Technically called Exercise-Related Transient Abdominal Pain (ETAP), a stitch is a pain in the lateral abdomen. They're brought on by activity and usually described as sharp or stabbing. Not ideal!

There have been many theories as to what actually happens when you develop a stitch. Is it a muscle thing? Could it be the ligaments supporting the stomach? Is it an actual stomach thing? 

The leading hypothesis is that the sharp pain is due to friction on the parietal peritoneum, which is the tissue that adheres to the diaphragm and the abdominal wall. We haven’t been able to confirm that with absolute certainty, but there are a variety of studies that have made this theory the frontrunner. 

For example, that tissue has been shown to be weakest in the area where stitch related pain is most likely to be reported, creates similar symptoms when stimulated directly, and is proportionally larger in children (who report stitches at higher rates than adults). 

Who gets them?

At any given running event, approximately 1 in 5 runners will experience stitch-related pain. Rough!

Body type and sex don’t seem to play a role, and while more experienced runners tend to develop them less frequently, fitness certainly doesn’t equate to immunity. Age is also helpful, with adults being less likely than children to report pain. 

One thing to note: The influence of a proper warm up is largely anecdotal. We don't have great research to support it, but that doesn't mean that a good warm up isn't vauable for other reasons!

Make them stop!

Since we don’t know exactly what causes a stitch or what makes some folks more susceptible than others, there isn’t always a clear solution. Here’s what we do know:

1. Posture check
   
   Research shows that those who run with a rounded upper back are more likely to experience a stitch. The more rounded your back, the greater the frequency and severity.
   
   In the moment, try rolling your shoulders backwards a few times. If it's a consistent problem, it's worth working with a pro to develop a strategy.

2. Core strength and function
   
   Dynamic trunk stability has been shown to be an effective prevention strategy. Researchers suggest that better strength and coordination in the abdominals might limit how much the abdominal contents can move, leading to fewer incidences of pain.
   
   Putting pressure on the area (i.e. “digging in”) may also help, and it's believed that it's due to similar mechanisms as solid core function.

3. Breathe
   
   The evidence doesn't show one most beneficial strategy, but it is believed that breathing could be a key to relief.
   
   Try breathing deeply. Consider prolonging your exhale. See if a focus on expanding your ribs to the sides helps.

4. Consider your approach to fuel
   
   Avoid eating or drinking too close to a run. This is especially true of fluids that are high in sugar or salt. "Training your gut" is a thing! Practice your fluid and nutrition intake and your tolerance will improve.

A few other common recommendations include bending forward or stretching. Both of these strategies have mixed results in studies; they probably won’t hurt you, but the evidence suggesting that they’ll offer relief is pretty limited. We’ll call them anecdotal, at best. 

In short, if a side stitch is holding you back, know that you’re in good company. Do a quick scan of the strategies above, knowing that the solution may vary amongst individuals and even amongst each occurrence. If these things become persistent for you, it might be worth having them assessed. Even without certainty about the exact causes, there’s a lot we can do to try to give you the best shot at stitch-free running!

As always, we’re here to support you in getting the most out of your run. If you’re curious as to how we can help you reach your running goals, let’s connect!

Interested in a deeper dive?

As always, we love a good dive into the current research. Here’s a great overview of the current research:

Morton D, Callister R. Exercise-related transient abdominal pain (ETAP). Sports Med. 2015 Jan;45(1):23-35.

You can access it free here.