The side stitch, also referred to as exercise related transient abdominal pain (ETAP), is a common condition experienced at one time or another by most people who regularly engage in sports or exercise.
Characterized by a sharp, stabbing pain just beneath the ribcage, this frustrating cramp occurs most frequently during vigorous activity that involves a lot of up and down movement, such as running or jumping. The pain is caused by a spasm of the diaphragm muscle when the ligaments extending from the diaphragm to the internal organs (particularly the liver) are stretched.
Though it can occur on either side of the abdomen, the side stitch occurs much more frequently on the right side. Why is that? When you inhale, your lungs fill with air, and your diaphragm is forced downward. When you exhale, your lungs contract and your diaphragm rises. While running, approximately 70% of people exhale as their left foot hits the ground with only about 30% of people exhaling as their right foot hits the ground. The latter group is more likely to experience side stitches. As the right foot hits the ground, gravity pulls your internal organs, including the liver, downward. If you are exhaling at the same time, then your diaphragm rises as your lungs contract, resulting in stretching of the diaphragm. This repeated stretching can lead to spasms in the diaphragm.
To treat a side stitch, it is best to stop, or at least reduce the intensity of, the activity that caused the stitch. Take deep, even breaths until the pain subsides. Applying manual pressure to the painful area can also help to alleviate the pain. If you tend to exhale as your right foot touches the ground, try to adjust your stride so that your left foot hits the ground as you exhale.
There are also steps you can take to prevent side stitches from occurring in the first place:
- Stretch thoroughly before exercising, focusing on the lower back and abdominals.
- Avoid eating for one to two hours before a workout, because food in the stomach can create more force on the ligaments and increase cramping.
- When running, make sure to take deep, even breaths, as shallow breathing leaves the diaphragm consistently raised, not allowing the ligaments to lower far enough to relax.
- Drink more fluids to avoid dehydration, which can increase muscle cramps.