Quick Answer
To stop a side stitch mid-run: slow to a walk, take slow deep belly breaths (abdomen expands, not just chest), press two fingers firmly into the painful spot for 10 seconds, and raise the arm on the affected side overhead while leaning away. Most stitches resolve within 2–5 minutes. To prevent them: don’t eat within 2 hours of running, avoid sugary drinks, warm up properly, practise diaphragmatic breathing, and build core strength.
What Is a Side Stitch?
The medical term is Exercise-Related Transient Abdominal Pain (ETAP). It typically presents as a sharp, stabbing, or cramping pain on one side of the abdomen, usually just below the lower ribs. Some runners also feel a referred ache at the tip of the shoulder on the same side — a symptom linked to diaphragm irritation, where pain is referred upward along the phrenic nerve. The pain usually comes on during moderate-to-high intensity running and will typically subside quickly once you slow down.
Stitches are not serious or harmful — there is no evidence they cause lasting damage — but they are genuinely painful and can derail training sessions and races. They are most common in beginner or developing runners but affect experienced runners too, particularly at higher intensities or when pre-run nutrition timing is poor.
What Causes Side Stitches? The Leading Theories
Despite decades of research, there is no definitive single cause for ETAP. The three most supported theories are:
Diaphragm spasm from respiratory fatigue. The diaphragm is the primary breathing muscle — it contracts on every inhale and relaxes on every exhale. When running intensity increases, breathing rate rises, and if breathing becomes shallow (chest-only rather than belly breathing), the diaphragm works harder without fully lowering on each inhale. Over time this sustained partial-contraction causes the muscle to fatigue and spasm. This theory explains why stitches are more common in less-conditioned runners whose diaphragms are not yet adapted to sustained exercise breathing demand.
Parietal peritoneum irritation. Research published in Sports Medicine (Morton & Callister, 2014) suggested that ETAP may be caused by irritation of the parietal peritoneum — a thin membrane lining the abdominal cavity and the underside of the diaphragm. Repetitive torso movement during running can cause friction between the two layers of this membrane, particularly when the stomach contains food or fluid that adds bulk and movement. This explains why eating or drinking shortly before running increases stitch risk.
Liver ligament strain. The liver — the largest abdominal organ — sits in the upper right abdomen and is attached to the diaphragm by two ligaments. With each footstrike, the liver bounces downward while the diaphragm moves upward during exhalation. If exhalation consistently syncs with the right footstrike (a common breathing pattern in runners using an even stride-to-breath ratio), this creates repeated tension on these ligaments. This is the most compelling explanation for why stitches are approximately twice as common on the right side in adults.
How to Stop a Side Stitch Mid-Run
When a stitch strikes, these steps work consistently for most runners:
Step 1: Slow down immediately. Dropping from a run to an easy jog or walk is the single most effective action. Reducing intensity lowers the breathing demand on the diaphragm and reduces the repetitive impact loading on the abdominal organs. Do not try to run through an active stitch at full pace — it typically intensifies with continued effort.
Step 2: Breathe deeply from the belly. Shift from shallow chest breathing to diaphragmatic (belly) breathing. To do this: inhale slowly and deeply so your abdomen expands outward rather than your chest rising. Hold briefly, then exhale fully. The goal is to fully lower the diaphragm on each inhale, reducing the sustained partial-contraction that causes the spasm. Take 4–6 slow, deliberate belly breaths while walking.
Step 3: Press the painful spot. Using two fingers, press firmly into the most painful point and hold for 10 seconds while continuing to breathe deeply. Applying upward pressure (toward the rib cage) is often more effective than straight inward pressure. This can break the spasm cycle in the surrounding muscles. Gradually reduce pressure as the pain diminishes.
Step 4: Stretch the affected side. Raise the arm on the side of the stitch directly overhead as high as possible, then gently lean your torso away from the pain. This stretches the abdominal muscles and intercostals on the affected side, which helps relieve the cramping sensation. Hold for 15–20 seconds.
Step 5: Resume gradually. Once the stitch has eased — usually within 2–5 minutes — begin running again at an easy pace. Focus on maintaining deep, rhythmic breathing as you build intensity back up. If the stitch returns immediately, repeat the sequence or walk until fully resolved.
The Purse Lips Breathing Technique
An additional technique recommended by sports medicine practitioners is the “pursed lips” method: as you exhale, purse your lips as if you are slowly blowing out a candle. This slightly increases exhalation resistance, which slows the breathing cycle and forces the diaphragm to fully lower on each inhale rather than staying in a semi-elevated position. It can be used both to treat an active stitch and as a preventive breathing technique during hard efforts.
Changing Your Footstrike-Breathing Pattern
Most runners unconsciously sync their breathing to their stride in an even ratio — for example, inhaling for two steps, exhaling for two steps — which means exhalation repeatedly occurs on the same foot. When this syncs with the right foot (the side of the liver), it creates repeated simultaneous downward pressure from the liver and upward diaphragm movement. To disrupt this: consciously shift exhalation timing by trying a 3:2 or 5:3 inhale:exhale ratio, so exhalation alternates between left and right footstrike. This odd-ratio breathing pattern is harder to maintain consistently but can help runners who get stitches repeatedly on the same side.
Prevention: 7 Evidence-Backed Strategies
1. Manage pre-run nutrition carefully. Allow at least 2 hours after a normal meal before running, and 3 hours after a large or fatty meal. High-fat and high-fibre foods slow gastric emptying and are the highest-risk foods for triggering stitches. Avoid sugary drinks and concentrated fruit juices before runs — studies have found these increase stitch incidence compared to water or dilute sports drinks. For race-day nutrition timing, see our guides on what to eat before a 5K and what to eat before a 10K.
2. Warm up properly. Starting a run at full effort without a gradual warm-up forces an immediate spike in breathing demand that the diaphragm is not prepared for. A 5–10 minute easy warm-up walk or jog, combined with some gentle dynamic movement, gradually increases breathing rate and primes the diaphragm for sustained effort. This is particularly important for interval sessions and races where you accelerate early. Our 15-minute stretching routine includes an effective pre-run warm-up sequence.
3. Practise diaphragmatic breathing. The most common reason novice runners get stitches is that they default to shallow chest breathing at higher intensities, fatiguing the diaphragm. Practising belly breathing during easy runs trains the muscle and the pattern. Lie on your back, place one hand on your belly, and breathe so your hand rises on the inhale — that is the target sensation. Apply the same technique while running easy until it becomes habitual.
4. Build core strength. One study found that runners with stronger trunk muscles — particularly the transverse abdominis (the deep stabilising core muscle) — experienced significantly fewer side stitches. Core strength improves running posture, reduces excessive trunk rotation, and supports the structures around the diaphragm. Our guides on best core exercises for runners and does running strengthen your core cover the key exercises.
5. Increase training load gradually. Stitches are significantly more common when you run faster or longer than your current fitness level is adapted to. The diaphragm, like any muscle, needs progressive training to handle sustained high breathing demand. Following a structured training plan that respects progressive overload prevents the sudden fitness spikes that make stitches more likely.
6. Stay hydrated — but not with sugary drinks. Dehydration was once blamed for stitches, but the research does not support that. However, drinking large volumes of fluid immediately before or during running can contribute by adding stomach bulk. Sip small amounts of water throughout the day and during longer runs rather than drinking large quantities at once. If consuming sports drinks, use diluted formulas (under 6% carbohydrate) rather than concentrated juices or full-strength commercial drinks.
7. Identify and log your triggers. Keep a note of what you ate and drank in the 2 hours before any run that produced a stitch. Patterns usually emerge quickly — specific foods, drink timing, or effort levels that consistently precede stitches. Once your personal triggers are identified, you can manage them systematically.
👉 Swipe to view full table
| Prevention Strategy | Why It Works | When to Apply |
|---|---|---|
| No eating within 2 hours of running | Reduces peritoneal friction from organ bulk | All runs, especially hard efforts |
| Avoid sugary drinks pre-run | Concentrated drinks slow gastric emptying | All runs, especially races |
| Proper warm-up (5–10 min easy) | Prepares diaphragm gradually for effort | All runs, especially intervals |
| Belly breathing practice | Prevents diaphragm fatigue from shallow breathing | Easy runs (build the habit) |
| Core strengthening (2–3×/week) | Reduces trunk rotation and supports diaphragm | Ongoing strength training |
| Gradual training progression | Conditions diaphragm to handle intensity | Training plan structure |
| Log stitch triggers | Identifies personal risk patterns | After any stitch episode |
When Stitches Are Frequent or Don't Resolve
Occasional side stitches are normal and harmless. If you are getting stitches on nearly every run or the pain does not resolve within 5–10 minutes of slowing down, it warrants attention. Persistent or unusually severe right-side abdominal pain could indicate conditions unrelated to exercise — including gallbladder issues, kidney stones, or musculoskeletal problems — and should be assessed medically. Pain that radiates to the back or shoulder blade, comes with nausea, or persists long after exercise stops is not typical ETAP and should be evaluated by a doctor. For other running-related abdominal issues, see our guide to runner’s stomach and stomach pain when running.
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FAQ: How to Get Rid of a Side Stitch When Running
What causes side stitches when running?
The leading theories are: diaphragm spasm from shallow breathing, irritation of the parietal peritoneum from repetitive torso movement, and stress on liver ligaments. Eating or drinking too close to running, poor core strength, inadequate warm-up, and running above current fitness level all increase risk.
How do you stop a side stitch mid-run?
Slow to a walk, take slow deep belly breaths, press two fingers firmly into the painful spot for 10 seconds, and raise the arm on the affected side overhead while leaning away. Most stitches resolve within 2–5 minutes with this approach.
Why do I always get a stitch on the right side?
Because the liver sits in the upper right abdomen and is attached to the diaphragm by ligaments. Running bounces the liver downward while the diaphragm moves upward on exhalation — and for runners who exhale consistently on the right footstrike, this repeated tension on the ligaments produces a right-side stitch.
Can core strength reduce side stitches?
Yes — research shows runners with stronger trunk muscles, particularly the deep core (transverse abdominis), experience fewer stitches. Adding 2–3 core sessions per week significantly reduces stitch frequency for many runners.
How long before running should I eat to avoid a stitch?
At least 2 hours after a normal meal, 3 hours after a large or fatty meal. Avoid sugary drinks (fruit juice, concentrated sports drinks) before running. Small, easily digested snacks 30–60 minutes before easy runs are generally tolerated well.
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