How to deal with runner’s side stitch

This one goes out to all my fellow runners out there!

How many of you have experienced the dreaded side stitch? I personally would rather have aching, sore legs during an entire run than experience a side stitch. I can push through sore legs. Side stitch? Not so much.

If you’re not familiar with the trendy name for a side cramp, it’s pretty much an aching, sharp, stabbing pain in your abdomen, just below your ribs. According to, a few survey-based studies on runners and other athletes who develop side stitches in an athletic event have established that eating a large meal or drinking concentrated, sugary fluids like fruit juice close to the time of the competition will increase your risk of developing a stitch.1 In addition, dehydration and inadequate electrolyte concentrations are also known to contribute to muscle cramping and side stitches.2,3

So how can we deal with them?

First thing, we need to prevent side stitches from occurring, or at least decrease our chances of getting them. This can be done by ensuring proper hydration by drinking enough water the day BEFORE your run and the hours leading up to your run. Don’t think you can skimp out on proper hydration the day before a workout. A fit lifestyle is a cycle and everyday will contribute to your workout performance. The day before a workout, the day of, and the day after are all equally important. So, make sure you’re consuming enough water on a daily basis.

Latest recommendations suggest letting thirst be your guide: if thirsty, drink (exceptions include infants, vigorously exercising athletes, hospitalized patients, and the sick and elderly, who may have diminished thirst sensations). I get a lot of my fluid needs by eating a whole foods diet that is very high in water content (lots of fruits and veggies plus orange juice and coconut water), but sipping on water throughout the day is not a very good habit of mine. I have to consciously make an effort. Plus there are days where my fruit/vegetable intake might not be as high, so I have to make sure to increase actual water intake. Do what works best for you!

One thing is for sure, if you find yourself craving fruit, soda, or other high sugar beverages, YOU ARE DEHYDRATED! Use that willpower of yours and down a glass of water before you take a sip of soda. Trust me, you will notice a difference immediately.

Second, electrolytes are some of the minerals needed in our diet which can also prevent cramping and side stitches from occurring. My personal go-to for electrolytes is coconut water; this way I’m hydrating and getting electrolytes at the same time. Proper hydration with electrolytes maintains the blood’s light viscous flow, increasing the amount the heart can pump and improving performance through heartbeat efficiency and smooth, concise, yet strong muscle contractions.3 Include coconut water, dark leafy greens and other veggies, beans, nuts/seeds, fruit, and use sea salt (refined salt has it’s minerals stripped!) to ensure you’re getting enough minerals in your diet and therefore proper electrolytes. If you’re eating a whole food diet that is naturally low in sodium, do not be afraid of using sea salt in your food, sodium is an essential nutrient/electrolyte (this varies with certain population such as those with chronic kidney disease; e-mail me if you need help determining your sodium level).

In addition to preparing (and recovering) from a run or workout, proper fueling during the run/workout is also an effective way of preventing side stitches. This is especially important for a workout lasting more than an hour, but for some individuals proper hydration for even a 30 minute run is essential. This is especially true for those of us running in really hot, humid conditions (hello Florida!). This also varies among the individual, the duration, and intensity of the workout. Some people like to sip on Gatorade during a workout because of the added electrolytes, but there are some waters (Smart Water) or Vega’s electrolyte hydrator powder that can be used during your workout.

Last but not least, there are additional measures that can prevent side stitches other than nutrition. Warming up (rather than going into a full-on sprint or jog right away) can also help. This allows you to gradually increase your intensity and gently bring up your heart rate, enabling you to focus on your breathing technique. Short, shallow breaths can contribute to a side stitch.

Next time you find yourself with the dreaded side stitch, focus on taking deep, long breaths. This may sound cheesy, but I like to focus on the area that’s hurting while I’m taking a deep breath as if I’m directing oxygen to the area and healing the stitch. (I’m not crazy, try it.) As frustrating as this is, you can also stop running so that you can bend your torso in the opposite direction of the pain, holding this position for 30 to 60 seconds. I guess preventing a side stitch from occurring is ideal. But the good thing is that you can overcome a side stitch during a run. 

Do you have any personal methods or recommendations to dealing with a side stitch?

  2. Nutrition for Sport and Exercise; Marie Dunford and J. Andrew Doyle.
  3. Thrive Fitness; Brendan brazier: pg 159-160.

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