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.
Getting side cramps doesn’t mean you are out of shape; experienced runners get them, too. “I get side stitches at almost every race, especially going up and down hills,” says Jodi Thirtyacre, captain of the Kaiser Permanente training teams.
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:
Studies have found that maintaining a steady intake of oxygen seems to be the most important thing you can do to prevent side stitches. “It takes a real conscious effort to maintain steady, rhythmic breathing while you run,” says Thirtyacre. 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.) Thirtyacre says she also listens to music and breathes to the beat or keeps a beat in her 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, experts say, 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 for me is to have a methodical routine the week before a race, drinking 8-10 glasses of water a day at regular intervals,” Thirtyacre says.
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.
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. “I carefully plan my day-before-a-race meals; I drink lots of water, and I still expect a side stitch at every race,” says Thirtyacre. But when you get a cramp, try not to stop. “I used to stop when I’d feel one coming, but it would keep getting worse. Now I slow down a bit, but keep going and work through it. I concentrate on keeping a nice even breathing pattern and hum to myself if I don’t have music.”