Dear Alice,

Are there any good ways to prevent a side stitch? I know that one should breath out heavily if the stitch has already developed, but by then it's usually too late.

Dear Reader,

Unfortunately, physical activity may be painful in more ways than one for some. Many people experience a side stitch, which is a sharp pain in the side of the abdomen, when they're active. This condition, technically referred to as exercise-related transient abdominal pain (ETAP), is thought to be related to a number of different causes including lack of blood flow to and cramping of the diaphragm, stress on ligaments that attach to the side of the body or organs, muscle cramps, and lack of blood flow in the gastrointestinal system. However, one of the more widely accepted explanations for ETAP is the friction between two layers of abdominal tissue, called the parietal and visceral peritoneum. Luckily, there are multiple ways to decrease your chances of experiencing ETAP so you can keep up the sweat.

Side stitches may occur with any type of physical activity, but seem to be most commonly associated with activities that require rotation and movement of the torso, such as sprinting, jogging, and swimming. Therefore, if you’re getting side stitches frequently from any of these activities it may help to switch up your routine from running to biking for example. If you want to stick with your existing regimen, here are some suggestions that may help to lower the frequency at which side stitches occur:

  • If you find that you usually get stitches when you’re active after eating, try delaying activity for a longer period of time after eating. Eating causes the stomach to expand and the space between the tissues to decrease, in turn upping your chances of friction between the layers.
  • Sticking to long, low intensity workouts, instead of quick, high intensity ones.
  • Warming-up and gradually picking up the workout pace may help regardless of activity intensity. This is especially true in colder environments.
  • Strengthening your abdominal muscles and diaphragm, along with good posture, has been shown to help prevent or decrease the frequency of side stitch occurrences.
  • Some researchers found that people with better aerobic fitness tend to get fewer side stitches. Therefore, the more you build up your endurance and cardiovascular fitness, the less likely you are to wind up with a side stitch.
  • Try avoiding shallow breathing; try instead taking slow, deep breaths during physical activity.

If these prevention strategies fail to help, and you do get a side stitch, slowing down and breathing deeply (as you mention) is one way to alleviate the pain. Other strategies you might try are: bending over while tightening your stomach muscles a few times; stretching your abdominal muscles by reaching overhead with both your arms; and applying pressure to the area with your fingers, giving yourself a sort of "pressure massage" at the source of the pain. To do this, try pushing your fingers deeply into your stomach in a spot just below your ribs, while pursing your lips and exhaling as hard as you can. Simply grunting loudly while breathing out may also help, in addition to slowing down until the pain is gone.

Occasionally, side stitches might be mistaken for chest pain from lack of oxygen to the heart. If your pain is concentrated under the breastbone, radiates down your left arm, makes you out of breath, or is a result of physical activity, it’s recommended that you stop what you’re doing and seek medical attention immediately, as these symptoms may be potentially indicative of a serious condition, such as a heart attack.

Hopefully, implementing some of these strategies and listening to your body will ensure that you can ditch the stitch during your next workout.

Alice!

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