Physiology

Side stitch: what causes that sharp pain under the ribs

A stitch can stop a run in its tracks. It is harmless, but knowing what triggers it helps you avoid it and ease it faster.

A side stitch is a sharp or cramping pain just below the ribs, most often on the right side, that appears during running, swimming or horse riding. Its scientific name is exercise-related transient abdominal pain. It is common in young people and beginners, and while it can be intense enough to force you to stop, it is not dangerous and fades within minutes once the activity eases.

The exact cause is still debated. The leading explanation is irritation of the parietal peritoneum, the sensitive lining of the abdominal wall, which is jostled by repeated up-and-down movement of the torso, especially when the stomach is full. Large meals or sugary drinks shortly before exercise clearly make stitches more likely, and so does a weak or poorly braced trunk. Older theories blamed the diaphragm running out of oxygen, but stitches also appear in activities with little breathing strain, so that is probably not the whole story.

To prevent stitches, avoid big meals and concentrated sweet drinks in the two hours before running, warm up gradually and build mileage step by step. Trunk exercises such as planks and dead bugs may help over time. If a stitch hits, slow down, breathe deeply and steadily, and press firmly into the painful spot while bending slightly forward. Pain that comes with dizziness, chest pain or does not settle with rest is not a typical stitch and should be checked by a doctor.

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