Updated: September 25th, 2021
Cramp in all its glory: The side stitch explained

You’re one lucky egg if you haven’t felt the wrath of cramp whilst running.
Like a headache, cramp is an umbrella term and how you prevent or deal with cramp on the run are all different, depending on the type of cramp you’re experiencing.

There are three major types of cramp you get whilst running:

  1. Side cramp (or side stitch)
  2. Muscle fatigue cramp
  3. Electrolyte imbalance cramp

Okay okay, you may be that lucky egg not having yet experienced cramp, however, if you’re looking at increasing your milage and stepping into marathon distance territory; pull up a chair and read on.

As a sports injury professional and fellow runner, I find you must get to know all about your body. What’s going on, why you’re experiencing pain, and how to help it go the distance. A little knowledge stops you from expending your energy on worrying rather than placing one foot in front of the other.

Remember you are not alone; cramp gets its grubby little hands on all of us at one time or another and for multiple causes. Have a read, be ready and understand when cramp is lurking before it hits full storm. Get to know cramp well, cause it is likely you may come to be pretty familiar acquaintances…

Running cramp

Side cramp (side stitch)

Cramp in your arm… I’m joking!

As the name quite obviously suggests, this is cramping on the side, lower abdomen area. Often described initially as a pulling, aching feeling – usually felt just under the ribcage and can occur on either side of the body. Otherwise called exercise-related transient abdominal pain (if you’re a fancy doctor type). It is most common in the Youth appose the older runner mainly due to stitch decreasing with improved fitness levels.

Why does stitch impact runners?

Simply due to the repetitive torso movement that is easy to impede your breathing mechanics. Taking on fluid as you run, can also bring on the side stitch, similarly eating excessively before heading out of the door. Although, ‘Diaphragmatic ischemia and spasm’ or as we shall call it, shallow breathing is considered the main cause of side stitch within the athletic population.

Shallow breathing occurs with a lack of breathing deeply and engaging the diaphragm within the breathing process (either due to excessive torso rotation or lack of breathing mechanic technique). Either way, the running motion impedes you from utilising the entire lung capacity. Decreasing your oxygen intake, affecting vo2 max and how your body an utilising the oxygen.

Man breathing whilst running

Sometimes it’s pre-race-jitters. Getting to the start line can cause some shallow rapid breathing, so practise full deep breathing waiting to cross the start line. Also, the first 10 minutes or mile is usually the most nerve-wracking, so take it easier there too. Not crazy enough to hamper your time (that could make you more nervous!!) But be gentle, especially if you find some pre-race nerves rising.

Sounds a bit daft… not breathing properly, but it is true. The initial aches and pulling pain that arises is a warning sign – if ignored it can become a much more painful stabbing sensation and force the running to stop to get sufficient oxygen into the body.

How to stop a stitch whilst running

At the first sign of side pain, slow your pace. This is your warning, so use it DO NOT IGNORE IT.

According to research, there are Four ways to stop your stitch depending on severity:

  1. Slow pace right down, bend forward and push your hand inward and upwards on the area of pain. Tense abdominal muscles as if to resist a blow to the stomach and breath out of pursed lips.
  2. Change breathing-foot strike cadence. (This may take some awareness) if your side stitch pin is on your right, and you exhale when your right foot strikes the floor then SWAP. Instead, exhale when the left foot strikes the ground instead. (Vice-versa for a stitch that is on the left-hand side).
  3. If the stitch is too unbearable to continue – stop running! Bring it down to a slow walk, arms raised overhead. (to stretch it any tightness) and ensure deep belly breathing – seeing your belly move with inhalation and exhalation).
  4. Alternatively, if this is still too painful; lay on your back with your hips. Elevated. This is proven to relieve stretch within a few minutes. (Mid-race? Get out of the way of running flow of traffic best you can)

Runner morning arms up for cramp remedy

How to prevent a side-stitch from happening

  • Avoid taking large gulps of water whilst running. Little small sips are sufficient to see you through. One helpful tip I received through my first marathon was at a water station to grab a cup. Run with it a few steps and let the excess sloshing water fall out of the cup. What is left will be plenty enough to drink to avoid the side stitch.
  • Practise ‘belly breathing’ there is so much to say about chest breathers vs belly breathers. And it is surprising just how much it can affect your running. Do yourself a favour and read about belly breathing. It could be the difference between a DNF and a finishers medal.
  • Warm-up with controlled pre-stretch torso twisting. Done with arms overhead (I’m an arms at shoulder height and elbows fully flexed so hands can be behind my head kind of girl) to ensure my torso is stretched out and used to the rotating movement for the next few hours.
  • Don’t forget core work within your training plan workouts. Core exercises such as plank and the wonderful variations:

    – Rolling side plank
    – Hip dip plank
    – Plank with a side crunch
    – Hands to elbow plank

  • All geared to help keep the body prepared for running mechanics; especially the rotating exercises.

Women workout plank

Side stitch is SOO common, so don’t fret if you experience it — it’s annoying and painful but it will subside after a few minutes. So relax; after all, no one ever died from a side stitch.

Next, we look at muscle cramps from fatigue and overload; how can you prevent it? How can you stop it mid-run? What does it feel like and what are the warning signs?

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