Fending Off Painful Side Stitches Requires Thoughtful Approach To Fueling, Warm-Up, Breathing

By Elizabeth Carey for DyeStat

Side aches are a real pain in the athlete’s, err, side. 

When they strike mid-exercise, they feel like a cramp or stabbing pain near your ribs or stomach, generally on one side. They make it hard to breathe and may radiate discomfort in your shoulder, too. They don’t last long and often resolve when you take a break. Side stitches, as they’re also called, are a common nuisance for runners and athletes of all abilities, but especially younger athletes.  

Researchers have a few theories about what, exactly, causes this “exercise-related transient abdominal pain.” It may be pre-workout fuel — high volumes, close timing, or certain types of food and drink. It could be posture or muscle strength or lack thereof, of the diaphram (a sheet-like muscle) or core (the musculature of your torso and hips). It could be, well, the motion of running, intensity, or even a lack of experience. Additional anecdotal hypotheses include insufficient warmup and intense weather conditions like cold or heat.   

To avoid side aches, start by experimenting with your pre-workout fueling and hydration. What works, and what doesn’t, for you? (Pro tip: What works for someone else — say, a pro runner — might not work for you and that is A-OK!) So look inward and/or to a qualified registered dietitian, not outward or on Instagram or TikTok, for quality advice.

In our book Girls Running: All You Need To Strive, Thrive, And Run Your Best, Melody Fairchild shares a tip for those who get cramps in their torso. Before you run, she says, practice a gentle spinal twist with deep breathing. Ideally, you do this lying down, which she describes in-depth, but you can try it standing up, too. The idea is to rotate your spine and adjust your ribs so your lungs, intercostal muscles, and diaphragm relax and expand.  

You can also practice slow, deep breathing, which offers additional stress-busting benefits. This helps to undo the common muscular pattern of holding our chests tightly, says Fairchild. Remember, our ribs and torso house our lungs, which we want to be able to expand!  

Try this 30-second breath practice: Inhale for 10 seconds, hold for 10 seconds, and exhale for 10 seconds. Feel your lungs and ribs expand in every direction with each inhale and contract with each exhale. Repeat, working up to ten 30-second cycles. You can do this daily, or a few times a week, at any time.  

Some suggest core strengthening as an antidote. Start with activating your transverse abdominal muscle (deep abs) and go from there; see Girls Running for Melody’s 5-minute core routine.  

But what should you do if an ounce of prevention doesn’t work?  

If you get a side stitch on an easy run…

Slow down. Walk, if needed. Take some deep breaths. Practice forceful exhales. Try moving or stretching your torso and chest, whether with a twist, arm circles, or another motion. Restart slowly, focusing on your breath.  

If you get a side stitch during a workout…

See above. If a side ache hits during a priority workout, though, perhaps it’s time to practice the approach below so you’re primed for race day. Make a note in your training log about potential exacerbating factors — think: pre-workout fuel, warmup, conditions, etc.  

If you get a side stitch during a race…

Now’s not the time to stop or complain. Not to minimize your pain — believe me I can commiserate — but this might be the sole exception to my rule of not running through sharp, stabbing, or acute pain aka injury. In this case, practice stoicism to avoid getting pounced on by competitors. Think about it: if you’re racing behind someone who clutches their side or doubles over while whimpering or wheezing, wouldn’t that give you a surge of confidence? Most athletes will seize the opportunity to surge and pass with reignited confidence. If you’re a really nice person you might say, “You OK?” but even then that won’t stop you from moving up a place.  

Don’t be coyote bait, as Steens Mountain Running Camp Director Harland Yriarte says. Instead, try to breathe into the tightness and hang tough, as we say in our book. Practice rhythmic inhales and forceful exhales, and good luck.  

And, of course, if side stitches persist, see a health care professional (which I most certainly am not). 

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Elizabeth Carey (https://elizabethwcarey.com/) is a writer and running coach based in Seattle, Washington. Her first book, GIRLS RUNNING, co-authored with Melody Fairchild, is available at your local book store and here: https://shop.aer.io/GirlsRunning/p/Girls_Running_All_You_Need_to_Strive_Thrive_and_Run_Your_Best/9781948007184-9934.