Take a breather and stretch to ease a side cramp.

How to Prevent Side Cramps

Nothing slows you down like a side stitch, and like all runners, I dread getting one. The official term for this sudden, stabbing pain is exercise-related transient abdominal pain (ETAP), but side cramp, side stitch and side ache are the most common names.

Getting side cramps doesn’t mean you are out of shape; experienced runners get them, too. In fact, I get side stitches at almost every race, especially going up and down hills.

We don’t know exactly what causes side stitches, though there are lots of theories. These 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:


Studies have found that maintaining a steady intake of oxygen seems to be the most important thing you can do to prevent side stitches. So try to make a conscious effort to maintain steady, rhythmic breathing while you run. Try to 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.) I find it helpful to listen to music and breathe to the beat, and when I can’t do that, I keep a beat in my head.


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


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.


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.

Warm Ups

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.

Unfortunately, even with all that preparation, side stitches are still a normal occurrence during long runs and races. Even though I carefully plan my day-before-a-race meals and drink lots of water, I still expect a side stitch at every race. One thing I’ve learned is that when you get a cramp, it’s better not to stop. I used to stop when I’d feel one coming, but it would keep getting worse. Now I concentrate on keeping a nice even breathing pattern, humming to myself if I don’t have music. I slow down a bit, but keep going and work through it.

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.