Also called: Exercise-related transient abdominal pain; ETAP
Relief and prevention
Stretch
Breathing
Strength
The sharp pain under the ribs during a run that stops you. The likeliest explanation is irritation of the lining inside the abdomen, and a full stomach, dehydration and shallow fast breathing all make it more likely.
How common: Around 70% of runners experience it at some point in a year
What it is
Exercise-related transient abdominal pain is extremely common - most runners get it, and it is not dangerous. The leading explanation is irritation of the parietal peritoneum, the lining inside the abdominal wall, as it rubs against the visceral layer during repetitive movement.
The older explanations - diaphragm cramp, liver ligament traction, reduced blood flow - have largely fallen out of favour. The peritoneal model fits the evidence better, particularly the strong association with what and when someone drank before running.
What it feels like
- Sharp, localised pain under the ribs, most often on the right
- Coming on during running or other jolting exercise
- Sometimes referring to the tip of the shoulder
- Forcing a slowdown or a stop, and easing within minutes of stopping
- More common in beginners and after eating or drinking
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Peritoneal irritation
- The two layers of the abdominal lining rub against each other during repetitive jolting movement. Friction between them, particularly when reduced fluid is present between the layers, is the leading explanation.
- Eating close to exercise
- A full stomach increases the traction and the friction. Eating within one to two hours before running substantially raises the likelihood.
- Concentrated drinks before or during exercise
- High-carbohydrate and hypertonic drinks are strongly associated - more so than water. Fruit juice before a run is a classic precipitant.
- Dehydration
- Reduced fluid between the peritoneal layers increases friction. This is one of the reasons the drink type and timing matters so much.
- Shallow, rapid breathing
- Poor diaphragmatic breathing changes the movement of the abdominal contents and is associated with stitch. Deeper, slower breathing reduces it.
- Being unconditioned
- Stitches are far more common in beginners and reduce as training experience increases, though they never disappear entirely.
- Poor trunk endurance
- A weak trunk allows more movement of the abdominal contents with each stride. Trunk strengthening reduces the incidence in some studies.
- A stiff thoracic spine and poor posture
- Associated in several studies, plausibly through altered trunk movement and breathing mechanics.
- Cold weather
- Reported more often in cold conditions, possibly through altered breathing patterns.
Who tends to get it
- Newer runners, in whom it is far more common
- Anyone eating or drinking close to a run
- People drinking concentrated or sugary drinks before exercise
- Anyone with a habitual shallow breathing pattern
- Younger athletes, in whom incidence is higher
What makes it worse, and what settles it
Makes it worse
- Eating within a couple of hours of running
- Fruit juice or concentrated sports drinks before or during a run
- Shallow, fast breathing
- Running hard at the start without a build-up
- Continuing at the same pace once it has started
Settles it
- Slowing down and breathing deeply, which resolves it within a minute or two
- Pressing on the affected area and exhaling forcefully
- Leaving two to three hours after a meal before running
- Drinking water rather than concentrated drinks close to exercise
- Trunk strengthening and diaphragmatic breathing practice, which reduce the frequency
What actually helps
The short version: Most likely irritation of the parietal peritoneum, aggravated by a full stomach, dehydration and shallow rapid breathing
Strength work: Core: Transverse Abdominis; Core: Diaphragm - trunk endurance is associated with fewer episodes
Stretching: Trunk; Spine - side flexion and rotation before running
Massage: Not primary
Also worth doing: Avoid large meals and hypertonic drinks within 2 hours; deeper controlled breathing; pressure with the hand plus a forced exhale on the affected side often breaks it mid-run
What the evidence says: Benign and self-limiting. Trunk conditioning and meal timing reduce frequency. Worth including because it is common, easily fixed, and constantly asked about.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
The qFIT routine for this
Ready-made routineBreathing & Ribcage
qFIT already has this one built. It runs massage first, then stretching, then
strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
them.
Have more than one problem? Tick yours under My Problems on
My Profile and your Checklist's Routine list gains
Recommended for my problems — every routine for the problems you picked, merged
into one. Your picks stay private; that filter is the only thing they feed.
Get it checked if…
Abdominal pain that persists after stopping, or comes with vomiting or fever, is not a stitch
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Side stitch is harmless and self-limiting, resolving within minutes of slowing down. Frequency falls with training experience, better breathing mechanics and attention to eating and drinking timing. Abdominal pain during exercise that does not settle with rest, that is severe, or that comes with other symptoms is not a stitch and needs assessment - and any chest pain or breathlessness with exertion should be treated as cardiac until proven otherwise.
Prevalence basis: Sports medicine surveys
Others the same routine covers
These share the Breathing & Ribcage routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.