Avoiding painful side stitches

Side stitches or exercise-related transient abdominal pain (ETAP) is  not well studied, but it is thought to be caused by a lack of blood flow to the diaphragm which causes pain in the side or shoulder area.  While side stitches occur more frequently in people who are out of shape, most of us have experienced pain in our sides at one point or another.

One study found that although many people believed that age and fitness level to be the cause, neither seemed to be the case.  Instead, it was found that eating and/or drinking before exercise was a factor in getting a side stitch; food and drinks that were high in sugar or salt were more likely to cause problems.

So if a side stitch can happen to anyone, what do you do if it occurs during training or competition?

1. Start by breathing deeply into your abdomen (belly breathing).
2. Try pursing your lips when you breathe out to synchronize your breathing.
3. If you are on the move (e.g. running, or roller blading) you can try to get your breathing to fall in line with your foot movement.
4. Stretching may help to diminish the pain of a side stitch, raise one arm up in the air and lean to the opposite side of where your pain is.
5. If the pain really won't go away, slow down for a bit (five minutes) and continue when you feel well enough to start again.

The best thing you can do to avoid side stitches is to watch what you eat or drink before you exercise.  It is recommended that you avoid high fat or heavy foods and to try having smaller amounts more frequently if you know you are going to be exercising heavily. 

References from the SIRC Collection: 

1. Clark N. Undesired Sideliners: Side Stitches and Runner's Trots. Running & Fitnews. July 2010;28(4):21-23.
2. Erith M. Stitch - exercise related transient abdominal pain. Coach. November 2003;(19):42-45.
3. Morton D, Aragón-Vargas L, Callister R. Effect of Ingested Fluid Composition on Exercise-related Transient Abdominal Pain. International Journal Of Sport Nutrition & Exercise Metabolism. April 2004;14(2):197-208.
4. Morton D, Callister R. Influence of posture and body type on the experience of exercise-related transient abdominal pain. Journal Of Science & Medicine In Sport. September 2010;13(5):485-488.
5. Muir B. Exercise related transient abdominal pain: a case report and review of the literature. Journal Of The Canadian Chiropractic Association. December 2009;53(4):251-260.
6. Welch D. `Oh, the pain!'. Shape. October 1995;15(2):23.