Side stitch - a pain with many causes

“The problem with side stitch is always the same: whenever a doctor wants to examine it, it’s gone,” says Klaus Voelker, professor of sport medicine at the University of Munster in northern Germany.

The phenomenon always occurs during physical exercise but with a few simple behavioural changes you can avoid the pain or get rid of it quickly.

There are many theories as to what causes side stitch. Voelker believes it is plausible that it has something to do with blood flow.

When we exercise blood is pumped into our muscles while at the same time blood flow to our internal organs is cut. That can lead to cramps in the liver, stomach and intestine, which in turn can lead to side stitch.

It has also been observed that side stitch often happens when the stomach is full and in people who are not fully trained. “Blood flow does not work so well in a person who does not exercise regularly.”

When the stomach is full the body requires more blood there for digestion. There are also indications that on a full stomach the diaphragm can cramp up and cause side stitch.

Side stitch can appear during all stamina sports but it’s especially common during running. It is not known why that is but it is thought that during exercise gases in the intestine moving upwards might cause the pain, says Klaus-Michael Braumann, professor for sport medicine at the University of Hamburg.

Voelker thinks physical strain on the internal organs through violent movement might be the cause. “During exercise the organs are shaken,” he explains.

The experts advise not eating a substantial meal between two and three hours before exercising. “Small, easily digested food such as a banana can, however, be eaten later,” says Voelker. “The stomach should be neither too full nor too empty.” They also advise avoiding gas-causing foods such as nuts.

Sport scientist Dieter Bubeck from the University of Stuttgart also recommends drinking small quantities of fluids during exercise. However, he says you should avoid fizzy drinks completely.

It is also very important not to exert yourself completely right from the start of exercise. “From my own experience I can say that people who raise the level of exercise according to their pulse rate will experience less side stitch,” says Bubeck.

Side stitch can also affect well trained people but they are less likely to make the mistake of going jogging right after eating a meal.

If you do experience side stitch the best thing to do is take a break or to reduce your rate of exercise until the pain goes. Another piece of advice is to breath deeply without speaking at the same time.

You should also try to breath with your stomach. That way the diaphragm will be pressed upwards during inhalation. Braumann, however, is not convinced breathing plays a role. He believes that “the only thing that helps is to reduce the intensity of exercise.”