What is side stich?
Side stitch is a rather flimsy phenomenon. The scientific name is ”Exercise-related Transient Abdominal Pain” (ETAP), which can be translated into exercise-related transient pain in the abdominal region". In practice its an experience of a stabbing pain which most runners experience at some point.
You can get side stiich in the whole abdominal region, but its most common to get it on the side around the lower ribs - and in fact particularly on the right side. You won´t be in doubt what it is when you get it - it can be quite painful!
Can core-training help eliminate side stitch?
As the pain occurs in the abdominal region, its reasonable to think that it would help to do core training to strengthen the area.
If we take a closer look at the evidence, this is also unclear at the moment. Some results indicate that "inappropriate posture" can increase the risk of side stich. If we assume that this is true, core-training might be a good suggestion for a cure if your current core-musculature isn´t strong enough to maintain an appropriate posture.
Its difficult to say what the optimal posture looks like as we are all different! However, its specifically mentioned that people with an excessive curvature (also called "Kyphosis") may be at greater risk of getting side stitch. Below you may find a number of great exercises if you want to work with this;
My assessment of core training at the moment is that there is no harm in trying it and that it might help. If you struggle a lot with side stitch, I think it would be a good idea to try out if core-training can eliminate the problem.
As posture is a key issue, it might make sense to find out if you are very tense or weak in certain muscle groups which will affect your posture. If this is the case, its likely that your body can´t move in an optimal way. However, as I said, this is just guessing so you will have to try your hand a little.
How should you eat to avoid side stitch?
Overall, food and drinks shortly before a race will cause side stitch. However, research point to the fact that you can train your body in the sense that your stomach can grow better at tolerating food and drinks before and during an activity - especially when it comes to fluids.
However, fluid isn´t just fluid - the fluid which causes side stitch in the smallest degree is isotonic fluid. Perhaps you have come across this in various energy products. This fluid isn´t just water but has a ratio between fluids and salts and carbor hydrates which makes it easier for the body to absorb it which seems to lessen the risk of side stitch.
Both water without anything added as well as a "hypertonic" solution (water with lots of carborhydrates) provoke side stitch to a higher degree.
The recommendation for food and drinks are therefore the following before running:
- Eat light and in good time before running (2-3 hours before)
- Consume "isotonic" fluids
If you want to read more about the use of energy during running, I have written a longer piece on it here: ”Guide: How to use energy before, during and after running"
How common is it to get side stitch?
If we look more into the research, there isn´t really much to address. However, there is a comprehensive study from 2015, which highlights some statistical facts:
- In a study of 965 personer across six sports, 61% had experienced side stitch at least once during the past year. The sports included were swimming, running, equestrianism, team-fitness, basketball and cycling. The side stitch among runners was 10,5 times more common than in swimming.
- In another study of 110 triathletes, 68% had experienced side stitch during the past year, when we look at the running-discipline.
- During a single running-event (848 and 1254 test persons) 27% and 17% respectively reported having experienced side stitch.
So, there are many people who experience and running seems to be the sport that mostly cause side stitch.
Is it only untrained people who experience side stitch?
I have heard this but I am not really sure that its true.
If we look into the comprehensive study above, there are indications that welltrained runners don´t experience side stitch quite as often - your training status, however, doesn´t exclude the risk of getting side stitch, and the pain seems to be the same regardless of your status.
The connection between the amount of training done and side stitch is, however, not definitive, so the question can´t be answered completely.
Is there a connection between age and side stitch?
This is quite clear: One study among others have concluded that 77% under the age of 20 have experienced side stitch while only 40% in the group over 40 had experienced the same.
It also looks like the severity of side stitch wears off the older you get - the real reason for this is, however, is still unclear.
Is there a connection between gender and side stitch?
This area is not so clear. Some research reveals an increased frequency of side stitch among women while other studies reveal no differences.
If we look further into the quality of the different studies, then there are suggestions that there is no difference as studies with this result include more test persons among others.
Can you get side stitch from pure nervousness?
A completely new study with 168 runners have focused on this subject. During the study, it was discovered that there was a "moderate connection" between side stitch and stress (in relation to a so-called ”STICSA”-score).
Based on the fact that there is no currently other research on the subject, there is a great deal of uncertainty connected to conclusions, and therefore its up to each individual person if its relevant for you.
If you want to look into if there is a connection to you, its a good idea to make a log; of course in relation to if you experience side stitch but at the same time it would also be good to note other factors which can potentially cause side stitch for you - both in terms of what you have eaten and how long before your workout that you have eaten.
References
- Morton D., Callister R., Exercise-related transient abdominal pain (ETAP) (2015)
- Wynne JL., Wilson PB., Thorn in Your Side or Thorn in Your Head? Anxiety and Stress as Correlates of Exercise-Related Transient Abdominal Pain (2022)
- Seidi, F., Rajabi, R., Ebrahimi, I., Alizadeh, M. H., & Minoonejad, H., The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle., (2014)
