If you’re a regular runner, chances are you’ve been hit by a stitch. This stabbing pain in the abdomen – and in some cases shoulder – can strike seemingly out of nowhere and derail your best-laid race day plans. But is it avoidable?
The more I dug into this pesky phenomenon, the more mysterious it became. There’s a surprising lack of concrete answers on what causes a stitch, how to get rid of it while running, and measures you can take to avoid it altogether. But that doesn’t mean there aren’t theories as to the origin and proposed ways to mitigate the problem.
I scoured relevant studies and recruited University of Bath applied sports scientist Jonathan Robinson to help me provide the best answers possible.
What is a stitch?
In scientific circles, the stitch has another name: exercise-related transient abdominal pain, or ETAP for short. Despite being a commonplace ailment, this topic received little attention until the last decade or so.
Research published in the Sports Medicine journal states: “ETAP is especially prevalent in activities that involve repetitive torso movement with the torso in an extended position, such as running and horse riding. It tends to be sharp or stabbing when severe, and cramping, aching or pulling when less intense.”
This pain is most common in the abdomen, particularly along either side, but can also be “related to shoulder tip pain, which is the referred site from tissue innervated by the phrenic nerve”.
The 2014 study found that 70 per cent of runners surveyed reported experiencing a stitch within the last year, and “in a single running event approximately one in five participants can be expected to suffer the condition”.
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What causes a stitch?
“It’s one of those situations where there isn’t one definite answer,” Robinson tells me.
The 2014 Sports Medicine journal research states a range of suggestions for what causes a stitch, including cramping, limited blood flow to the diaphragm, compression of arteries, ligament strain, aggravation of the nerves and gastrointestinal distress. “Of these theories, irritation of the parietal peritoneum [a membrane which lines your abdominal and pelvic walls] best explains the features of ETAP; however, further investigations are required,” the article notes.
It’s often proffered that the up and down motion of running, and consequent movement of the diaphragm, could be what causes this.
“What counteracts that suggestion is that you can get a stitch while swimming, where there isn’t any impact,” says Robinson. “But what it does have in common with running is that there is twisting or rotational movement, especially if you’re doing backstroke or freestyle.
“Stitches seem to be a little bit less common in cycling, which is a bit more fixed. Occurrences also seem to be lower in walkers compared to runners, so intensity could be an issue as well. And of course, with walking, there’s not quite as much impact as there is in running.”
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How to prevent a stitch
With the cause of a stitch uncertain, management strategies remain fairly vague. But certain behaviours can reduce your chances of experiencing one.
“Even though there isn’t a specific cause as such, you tend to get similar recommendations for preventing a stitch,” Robinson tells me. “The timing of your eating is one. If you’re eating immediately before you’re exercising, I think that’s probably more likely to cause problems.
“Obviously, for people doing marathons, they will need to eat during exercise. But if you can make sure you’re not eating too much immediately before the run, and avoid foods massively high in simple sugar consumption – really sugary foods and drinks – that should help.”
This, he says, could potentially be linked to the proposed cause of gastrointestinal distress.
“Almost in contrast to that, you also want to make sure you’re well hydrated. Achieve that by gradually drinking little bits at a time rather than suddenly thinking, ‘Oh, I’m going for a run, I’d better drink a litre of Lucozade Sport’.”
Robinson’s final suggestion is to do a thorough warm-up before you set off on a run or start a race. If a stitch is caused by muscular strain, by priming the body, you can avoid it to start with, he explains.
The aforementioned study repeats several of these theories: “Commonly purported prevention strategies include avoiding large volumes of food and beverages for at least two hours prior to exercise, especially hypertonic compounds; improving posture, especially in the thoracic region; and supporting the abdominal organs by improving core strength or wearing a supportive broad belt.”
How to get rid of a stitch
If the techniques above still don’t ward off that mid-run stitch, the next best thing to know is how to get rid of it quickly.
The 2014 research says many touted cures are “largely anecdotal, especially given that its etiology remains to be fully elucidated”. In English: the cause of a stitch is still unclear, so remedies are based on experience and open to interpretation.
“The obvious solution is slowing down or stopping,” says Robinson. “A stitch does seem to subside pretty quickly when you do that, but obviously that’s not great when you’re in a racing situation.
“Slow down and focus a little more on your breathing. There’s some suggestion that synchronising your breathing with your running stride or pattern and avoiding really shallow breathing, may help – trying to breathe more effectively and efficiently. You might stretch the affected area as well.”
