Phila Massages

The Mysterious Side Stitch

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We’ve all been there at one point or another. Heading out for a daily run or walk feeling relatively fine just to be greeted shortly after by that sudden, sucker punch of a sharp pain along the side of the lower ribs taunting you to pull over and curl into a ball on the side of the road. You’ve managed to fight through those lingering old sports injuries in the past and even made it back to the gym after your trainer completely drove you into the ground earlier in the week, but there’s something about the infamous side stitch, also known as exercise related transient abdominal pain, or ETAP, that has you questioning yourself whether or not you could even make it one stride further.

What’s Going On?

What makes this whole crippling concept even more frustrating is that it’s not exactly known what causes a side stitch, however several recent theories have begun to explain some possibilities. It is believed to be a cramp in the diaphragm, the thin, balloon-like muscle that separates the chest and abdominal organs and helps force air into and out of the lungs during breathing. When you breathe in, your diaphragm contracts (tightens) and moves downward. This increases the space in your chest cavity, into which your lungs expand. The intercostal muscles between your ribs also help enlarge the chest cavity. They contract to pull your rib cage both upward and outward when you inhale. The opposite occurs during the exhale; the diaphragm relaxes and moves upward into the chest cavity. The intercostal muscles between the ribs also relax to reduce the space in the chest cavity. One of the theories suggests that side stitches are likely to be caused by the pumping action of the legs putting pressure on the diaphragm from below, while rapid breathing expands the lungs and puts pressure on the diaphragm from above. This “dual pinching” effect shuts off the flow of blood and oxygen, and causes pain and cramping.

Another theory states the possibility of consuming fatty foods too soon before a workout could put stress on the diaphragm.

A more complicated explanation is that a side stitch is caused by straining the ligaments that extend from the diaphragm to the internal organs, particularly the liver. The jarring motion of running while breathing in and out stretches these ligaments.




The Remedy:

Try these simple, yet effective techniques to reduce and prevent a side stitch from occurring:

  1. Belly breathing. Resist from taking shallow breaths while you exercise.  Breathe deeply and slowly, forcefully expanding the belly as well as the upper chest.
  2. “Poke and blow” technique. Push your fingers deeply into your belly just below your ribs, targeting the spasm site. At the same time, purse your lips tightly and blow out as hard as you can.
  3. Rest and Digest. Eat moderately-sized, low-fat meals 2-3 hours before practice or competition.
  4. Stretch. Right arm extended upward, lean to the left, hold for 20-30 seconds, repeat with the left arm stretched upward.
  5. Shore Up Your Core: Performing just 10 minutes of core-strengthening exercises three times a week can strengthen weak diaphragm muscles, making them more resilient to fatigue and less likely to cramp.



This article/video is for educational purposes only; do not attempt without your physician’s clearance. If you are in pain or injured, see your physician.

Copyright © Vidal Sports LLC 2018

Copyright © Vidal Sports LLC 2020

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