If you’re a runner, you know the sudden, sharp pain under your ribs that seems to appear out of nowhere—it’s commonly called a side stitch. While generally harmless, side stitches can be frustrating, interrupt your run, and make exercise uncomfortable. Understanding why they happen and how to prevent them is key to maintaining a consistent and enjoyable running routine.

At Town Physical Therapy, we specialize in helping runners prevent injuries and overcome exercise-related discomfort, including side stitches.

What Are Side Stitches?

A side stitch is a sudden, localized pain felt along the side of your abdomen during exercise. Medically, it’s referred to as Exercise-Related Transient Abdominal Pain (ETAP). Although most runners experience it under the right ribcage, it can occur on either side and sometimes radiate to the shoulder tip.

Side stitches are common among beginners, long-distance runners, and anyone increasing the intensity or duration of their workouts.

Common Causes of Side Stitches

Understanding the triggers of side stitches can help you avoid them:

1. Diaphragm Strain

Your diaphragm, the main muscle used for breathing, can cramp when overworked. Fast or shallow breathing during high-intensity runs can strain this muscle, causing sharp pain.

2. Ligament Stress

Ligaments supporting your internal organs can pull during movement, especially when running with twisting or jarring motions. This can contribute to the sharp, stabbing sensation of a side stitch.

3. Eating Too Close to Running

Consuming a heavy meal, sugary drink, or large snack shortly before a run can put pressure on your abdomen, limiting diaphragmatic movement and triggering side stitches.

4. Poor Breathing Technique

Shallow chest breathing instead of deep belly breathing reduces oxygen flow to your diaphragm, increasing the chance of cramping.

5. Dehydration

Insufficient fluids can make muscles, including your diaphragm, more prone to cramping. Proper hydration supports muscle function and reduces the likelihood of side stitches.

How to Prevent Side Stitches

Warm Up Properly

Dynamic stretches and light jogging before running prepare your muscles and diaphragm for activity. A proper warm-up increases blood flow and helps prevent cramps.

Practice Deep Breathing

Focus on diaphragmatic breathing: inhale deeply through your nose, letting your belly rise, and exhale fully through your mouth. This strengthens your diaphragm and improves oxygen delivery.

Mind Your Pre-Run Meals

Avoid large meals or high-sugar drinks 1–2 hours before running. Opt for light, easily digestible snacks if you need energy.

Strengthen Your Core

A strong core supports your diaphragm and improves running posture, reducing stress on abdominal muscles. Exercises like planks, bridges, and rotational twists are effective.

Stay Hydrated

Drink water throughout the day rather than chugging large amounts immediately before running. Proper hydration helps muscles function optimally and reduces cramps.

Tips to Relieve a Side Stitch During a Run

Even with precautions, side stitches may still occur. Here’s how to manage them:

• Slow your pace: Reducing intensity helps relax your diaphragm.

• Deep breathing: Focus on long, controlled breaths.

• Apply pressure: Gently press the area of pain while exhaling.

• Stretch: Raise your arms overhead or bend to the opposite side to relieve tension.

• Walk if needed: Taking a short walk can help ease discomfort.

When to Seek Professional Help

Most side stitches are harmless and resolve quickly. However, if you experience frequent, severe, or persistent pain, it’s important to consult a professional. Side stitches may indicate an underlying muscular imbalance, improper running mechanics, or other issues that benefit from targeted treatment.

How a Physical Therapist Can Help With Side Stitches

If you experience chronic or severe side stitch pain, scheduling an appointment with a physical therapist at Town Physical Therapy can make a big difference. A therapist can assess your posture, spine alignment, and core stability to identify any contributing factors. They can teach you proper breathing techniques to relax your diaphragm and abdominal tissues, and guide you through dynamic stretches for your neck, back, and core muscles.

Maintaining good posture while standing, walking, and running can reduce stress on muscles and nerves, improving your overall running experience. By enhancing your breathing patterns, blood flow, and core strength, physical therapy can help reduce or even prevent side stitches in the future.

At Town Physical Therapy, we also offer personalized running assessments, where a physical therapist will design a program tailored to your individual running goals and needs. This program isn’t just for competitive athletes—it’s perfect for anyone looking to run more comfortably, prevent injury, or recover from lower body pain such as knee, hip, ankle, or foot issues.

If you have questions about side stitch pain, proper breathing techniques, or sports-related injuries, request an appointment with Town Physical Therapy today and take the first step toward pain-free running.

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