How To Get Rid Of The Runners Side Stitch?

The other day I got hit by a dreaded side stitch. I haven’t had one of those since I was in junior school. But it’s not just minions like me getting struck by them. Last year a side stitch cost Javier Gomez Noya the title at the Ironman 70.3 World Championship. So some investigation is necessary.

How to get rid of the runner’s side stitch? Shorten your stride and slow down. You may even need to walk for a while. Place two fingers directly over the pain and push in and up while taking some deep breaths. When the pain subsides, slowly increase your pace again.

With the myriad of factors that potentially cause you to get a side stitch, it really helps to know which are the ones that impact you so that you can do something about them before the side stitch stops you.

Take It In Your Stride

A side stitch most often strikes as you are pushing out your stride length to gain that extra bit of speed, often over striding slightly.

So the best thing that you can do the moment the side stitch hits is to shorten your stride. Although, the chances are that the sudden pain will likely cause your stride to shorten automatically.

Place two fingers directly over the spot where the pain is. First push in almost as a way of grabbing the muscle. Then, press the painful area upwards. At the same time, straighten up as much as possible and take a couple of deep breaths.

Most of the time you can do all of this while still running slowly. If the process is not successful while running, repeat while walking.

Once you have relieved the stitch, ease back up to running pace gently. If you start up too quickly you risk getting a second, often worse, side stitch straight away.

Just a Temporary Cramp

First up, do not panic. It is only a cramp. You have not torn any abdominal muscles. And, the even better news is that the cramp is temporary.

In fact, the medical term for a side stitch is Exercise-related Transient Abdominal Pain or ETAP for short. This ETAP has nothing to do with the cycling power meters produced by SRAM. I must admit that if they were one and the same, I’d be willing to sell my abdominal ETAP for a lot less than $500.

Common Causes of the Side Stitch

A side stitch is that sharp pain that you feel just below your rib cage. From my experience, it seems to hit my obliques. However, there have been laboratory tests that show no difference in electrical activity in the muscles before, during, or after a side stitch.

That said, let’s unpack the five most common causes of a side stitch:

Running too soon after eating. This is the most common cause and one that I have experienced more times than I would like to admit. I’m pressed for time and head out for a run with a full belly straight after a large meal.
Drinking sweet beverages. Drinking a large volume of sweet beverage just before your run is just about as common as running after a meal. Your belly is full and your digestive system is under strain. If the beverage happens to be a large volume of carbonated soda then a side stitch is just about guaranteed.
Not warming up before a run. I have certainly noticed this. Although I can’t say that not warming up is a direct cause, but failing to warm up certainly increases my chances of getting a side stitch. When I add a cold, early morning race start it is even worse. My body does not like me sucking in large volumes of icy air without a warmup.
A curvature of the spine. In my research, I found a study from 2010 in the Journal of Science and Medicine in Sport that had found that runners suffering from scoliosis and weak posture were more likely to get a side stitch.
Shallow breathing. This is still in the realm of sports science theory and has yet to be fully tested in a study. From my experience, shallow breathing and a weak posture tend to go together. So it may well be that when this is put to the test it may be that posture is the culprit. When I run I’m so desperate to get as much oxygen as I can, that I breath as deeply as my posture will allow.

Not Only The Young

Sure it is true that side stitches are most common in the growing bodies of children.

That does not for a moment mean that as adults we can be complacent at all. The good news is that whether you get a side stitch at all and how quickly you get rid of it are all factors under your control.

Stop The Stitch

When it comes to getting relief from a side stitch, you have four options and for three of them, you should be able to keep running.

Finger push. Gently push two fingers directly into the painful spot, pressing in and then up. Most of the time this will be enough to ease the pain.
Alter your breathing/stride pattern. If your normal breathing pattern is to breathe in on the right foot strike and out on the left, then switch that around to breathe in on the left and out on the right. The other option which is what I do is slow my breathing down to in breath for two strides and out breath for two strides.
Completely change your breath cycle. Suck in a super deep breath quickly, forcing your diaphragm down. Hold that breath for a couple of seconds before exhaling forcibly through pursed lips.
Slow to a brisk walk. If all of the other options do not work, slow down to a walk and focus on deep breathing and an upright posture till the pain goes away. Then resume running, gently.

Prevention is Easy

By far the best option will be to not get a side stitch in the first place. Let’s have a look at your options for avoiding a side stitch.

Do those planks. A stronger core will help you maintain good posture. And a weak posture massively increases your risk of getting a side stitch.
Do the warm up. Besides your legs, a good warm-up includes the torso. This, in turn, gives greater flexibility to the muscles and connective tissue around the diaphragm. This is extra important when you are sucking in crisp, cold air during your run.
Eat mindfully pre-run. If you eat a large heavy meal just you head out on a long run you are simply asking for trouble. I do my runs early morning eating something super light just before heading out. If you’ve had a large meal it is best to wait between two and four hours before you run.
Breathe like a swimmer. This is one aspect where my triathlon training has really helped my running. When you swim it is only possible to breathe in with a relatively short intake of air when your mouth is clear of the water surface. You then exhale steadily, blowing bubbles into the water. This creates a rhythmic and deep breathing pattern which is ideal for running.
Ditch the soda. Carbonated soda is bad for you on so many levels beyond just causing side stitches. The only time I can see soda having value is to use it in training for an event that specifically has soda at the aid stations. And even so, still use the absolute minimum that you are able to.