There aren't too many runners who haven't felt an ache under their ribs when running. The medical term for the phenomenon is exercise related transient abdominal pain, but the more common name is "side stitches" or just "stitches." What causes stitches is not entirely clear, but several factors have been identified as possible culprits, particularly overeating before running. Taking preventive measures will get rid of most stitches, but if the problem persists, consult a doctor to rule out an underlying medical disorder.
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Side stitches are usually felt just under the rib cage on the right side of the body, although they can occur on the left side or both sides simultaneously. A severe stitch is usually felt as as sharp stabbing pain, while a mild stitch is typically described as feeling like a dull ache or pulling sensation. Stitches are more likely to appear in novice runners who are not in shape or in endurance runners who participate in triathlons or marathons. Once endurance is built up, stitches tend to decrease in frequency or stop occurring altogether.
What exactly causes stitches has eluded experts, but several conditions have been identified as contributing factors. Commonly cited conditions include dehydration, overhydration, overeating too soon before running, being out of shape, erratic breathing patterns and lacking strength in your core muscles – which are the muscles of the abdomen and back. Less commonly, medication or an underlying medical disorder is to blame.
To stay properly hydrated, drink water throughout the day of your run, and drink 1 to 3 cups of water just beforehand. Take only small sips of water while you are running, waiting until you are done exercising to fully hydrate. You should avoid beverages with high amounts of sugar and salt, including many sports drinks, as they are a common contributor to stitches. Eat a full meal no fewer than two to four hours before you run to allow for proper digestion. A small snack 30 minutes before running is fine if you skipped a meal. Work on increasing your endurance and strengthen the muscles of your abdomen and back. Gently stretch your abdominal area before running by twisting from side to side. Breathe evenly while running, taking three steps for every inhale and two steps for every exhale. Consult a doctor if your stitches persist despite taking preventive measures.
Stop running or slow your pace as soon as you start to feel the pain under your rib cage. Grab the affected area with your hand and apply pressure or massage it until the cramp goes away. Bending over at the waist can also help take pressure off the area. Breathe slowly, pushing your abdomen out when you inhale and relaxing it when you exhale. Drinking water might also offer some relief. Seek medical attention if the pain persists despite taking self-care measures.
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.