Stitch – what is it and how to prevent it?

The sharp, cramping, tugging pain in the side, known as stitch, is experienced by 70% of runners[1]. It can deter beginners from continuing running and force more experienced runners to stop or considerably slow down during races. Marathon star and Olympian Meb Keflezighi says he has lost races to stitches[2]. So what is stitch, why does it come about and how can it be prevented or treated?

In medical terms, a stitch is referred to as ‘exercise related transient abdominal pain’ or ETAP. It is usually felt on the right side of the abdomen immediately below the ribs during running.

Scientists have been baffled by stitch for decades. As the pain of stitch passes as soon as the runner stops activity it makes this mysterious condition tricky to study. However two main explanations emerge from the research on the subject.

Firstly there is stitch related to breathing and the diaphragm. The role that the diaphragm plays in normal breathing is to act like bellows beneath the lungs to ensure that we breathe in oxygen rich air when running. The jolting action which occurs during running puts pressure on the diaphragm and limits blood supply, therefore it begins to cramp and in turn gives the runner stitch[3].

The second explanation refers more to stitch as a ‘gastrointestinal complaint’, and is due to the type of food and drink consumed prior to running. Australian scientist Dr Morton, the most published scientist on the subject of stitch, concluded that irritation to the layers of membrane lining the abdominal wall result in stitch. Irritation arises when the stomach is too full or when the levels of protective fluid around the membrane drops caused by sugary drinks.

One explanation may resonate more with you, or like a headache you may feel that your stitch is caused by a combination of factors. Even Morton himself acknowledges that more research needs to be done into stitch in order to understand it fully.

So on a practical level, what can all runners do to prevent stitch?

  • Don’t consume sugary drinks (other than sports drinks) within 2 hours of running[4]. Water is the most straightforward way to remain hydrated, but take small amounts at a time to avoid bloating.
  • Foods that are higher in fat and fibre take longer to digest so they can trigger stitch, try carbohydrates only 2-3 hours before running.
  • Go through a warm up prior to your run, focusing on good posture/form and raising your breathing rate gradually[5].
  • Strengthen your deep core, such as the transverse abdominals and obliques.

But if you’re unfortunate enough to still get stitch how do you deal with it?

Slow your pace and exhale deeply as the foot on the opposite side of the stitch strikes the ground. So if like the majority of the running population your stitch is on the right side, exhale as your left foot strikes the ground.

Try stretching the area by reaching your hands over your head or by bending forward.

Or in Morton’s words “the most effective strategy for relieving stitch remains to stop exercising”… but where is the fun in that?!

[1]Morton, Callister, Exercise-related transient abdominal pain, 2000,
[3] Tim Noakes, Lore of Running, 2001, Pg 326.
[5]Tim Noakes, Lore of Running, 2001, Pg 326.

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