Side Stitch Pain During A Run: Why It Occurs And How To Eliminate It

Question: When I ran the other day, I didn’t make it far because I got that stitch pain in my side. After a mile, I couldn’t stand it and had to stop. I walked a few blocks, and then ran another mile. By the end, it came back again, so I gave up. Do you know what causes this? I’ve asked around, and I’ve heard irregular breathing, lack of sugar, lack of water, and even a lack of potassium. So, I wonder if something like Gatorade and/or a banana before running might help? Any suggestion?

Answer: There are two main theories for a side stitch, but both basically occur due to the same issue with the diaphragm: too much food or liquid ingested too soon before or during the run. The first theory states that the food or fluid can cause the bloodflow to be shunted away from the diaphragm causing pain due to inadequate oxygen supply to the diaphragm. The other states that there is enough food or fluid in the stomach to pull on the ligaments attached to the diaphragm as a result of foot contacts with the ground (Plowman & Smith, 2008). This also explains why the side stitch is associated with running and not with swimming or cycling.

To make sure it doesn't happen again, here are some recommendations according to Plowman & Smith (2008):

• Don't exercise immediately after eating a big meal or ingesting a large drink (close to 1 L).
• When drinking during exercise, consume small amounts (7-14 fl. oz.) more frequently rather than a single large drink at a rest stop.
• When running downhill, try to keep your breathing regular and your foot contacts light.

If it's too late, and you already have side stitch pain, you can do a couple of things:

• Breathe more deeply to move air into the lungs at the beginning of each breath, but do not try to force more air out on exhalation.
• Breathe through pursed lips (to contract the abdominals).
• Stop running, push on the spot that hurts, bend forward, and tighten your abdominals.

Based on the above information, I would suggest allowing 1.5-2 hours of time between eating and running to ensure proper digestion, and drinking roughly 15 fl. oz. of water 30 minutes before your run. Gatorade and other sports drinks are generally advised after 1-1.5 hours of exercise, so depending on the duration of your run, that may be helpful in terms of hydration and electrolyte balance.

Ryne Gioviano, M.S.Ed., NSCA-CPT

Owner of Welligee Personal Training & Lifestyle

www.welligee.com

Sources:

Plowman, S. A. & Smith, D. L. (2008). Exercise Physiology for Health, Fitness, and Performance (2nd ed.). Baltimore, Maryland, United States of America: Lippincott Williams & Wilkins.

Plunkett, B. T., & Hopkins, W. G. (1999). Investigation of the side pain "stitch" induced by running after fluid ingestion. Medicine and Science in Sports and Exercise, 31(8), 1169-1175.