Getting a side stitch when running is a common problem; here's what to do.

5 Tips for Preventing Side Cramps

If there’s one thing every runner dreads, it’s getting a side stitch. Also called a side cramp, a side ache, or by its official name, exercise related transient abdominal pain (ETAP), this sudden stabbing pain can stop you in your tracks. And of course, it’s not just runners who get them; you can get side cramps when swimming, playing sports, or during any kind of intense exertion.

Getting side stitches doesn’t mean you are out of shape, however. Even experienced athlets get cramps. And in fact, I get side stitches at almost every race, especially going up and down hills.

Interestingly, we don’t know exactly what causes side stitches. Theories include lack of oxygen, electrolyte imbalance, digestive issues, and pressure on nerves. However experts have identified several factors that contribute to side cramps and some techniques that work to prevent them. These include:

1. Remember to Warm Up

Running without a sufficient warm-up can leave you panting and gasping for breath, which is likely to trigger a stitch. Take time for a few minutes of fast walking, then a few more of minutes of easy jogging before you get up to speed.

2. Regulate Your Breathing

Studies have found that maintaining a steady intake of oxygen seems to be the most important thing you can do to prevent side stitches. What this means in practice is trying to maintain steady, rhythmic breathing. Which, of course, isn’t always easy to do while you run, but you can get better at it with concentration and practice. One tip from professional coaches is to match your breathing to your stride, which improves oxygen efficiency. For example, you might inhale for two strides, then exhale for two. (Or three, or four, depending on how fast you’re running.) One trick that works for me is to listen  to music and breathe to the beat. If I don’t have music with me, I try to keep a beat in my head.

3. Hydrate Consistently

Drinking too much water right before a run can cause a side stitch, but so can being dehydrated. The best solution is a compromise; hydrate consistently for a few hours before your run, but don’t drink a large quantity of liquid all at once. What works for me is to have a methodical routine the week before a race, drinking 8-10 glasses of water a day at regular intervals. Then I taper down my liquid consumption before the start of a race.

4. Maintain Electrolytes

What you drink matters, too, when it comes to side stitches. You want to replenish lost electrolytes, but you don’t want to overload on sugar. One study found that drinking sugary beverages, such as fruit juice or drinks made from fruit juice concentrate, can cause side cramps.

5. Manage Your Diet

For some people, eating too soon before a run can lead to side cramps. Keep in mind that foods high in protein and fiber are slower to digest, so you need to wait longer after you eat them before exercising. However, digestion is very individual so keep an eye on what works for you. If you notice you tend to get a cramp after eating certain foods, avoid them prior to a race.

Unfortunately, even with all that preparation, side stitches are still a normal occurrence during long runs and races. Even when I carefully plan my day-before-a-race meals and drink lots of water, I still expect a side stitch at every race. When I get one, though, I don’t freak out or stop running. Instead, I slow down a bit and work through it concentrating on my breathing. (It helps to hum!) Suddenly there will come a moment when I realize the cramp is gone.

Veteran marathon runner Jodi Thirtyacre works for Kaiser Permanente as the manager of the Department of Allergy, Asthma and Immunology at the San Francisco Medical Center. Jodi began running when she was only nine and ran track in high school. She kept up her regimen in college and ran her first marathon at 21. Jodi is the captain of Kaiser Permanente's teams for the Half Marathon and 5K.