You’ll brave below-freezing temps, that oversized bear of a dog your neighbor refuses to leash, and about a dozen other obstacles during your runs. But there’s one thing that can stop you dead in your tracks: side stitches.
Those cramps racking your stomach and knotting the muscles between your ribs are actually spasms in your diaphragm—a huge, dome-shaped sheet of muscle at the bottom of your ribcage. Your diaphragm plays a huge role in breathing, so yeah, it can really throw off your pacing and hurt your training if it’s constantly cramping up.
“When a stitch occurs during a workout or race, it’s best to stop and address the problem,” says Marni Sumbal, board-certified sports dietitian, R.D. “Rarely does ‘pushing through’ actually work when it comes to issues surrounding the gut or muscles,” she adds. It’s only a matter of time before the pain becomes too intense, or your form becomes so sloppy you’re forced to stop.
So, save yourself the additional pain and stop—immediately. “Take several deep, slow, concentrated inhales and exhales, and don’t start running again until the stitch has settled and your breathing is under control,” Sumbal says. You want your diaphragm to relax, fully, so start with brisk walking, then gradually get faster, slowly raising your heart rate and pace to where you left off.
But better than trying to manage the cramp once it starts is preventing it from ever happening in the first place, especially if you’re an athlete who’s chronically sidelined by stitches, Sumbal says. Here’s how.
1. Build a concrete core
“Strengthen your core with abs-centric exercises 3-4 times a week for 5-10 minutes per session,” Sumbal says. The goal is to bolster your muscles against fatigue since side stitches occur when your diaphragm muscles tire and start to cramp from stress. Perform exercises like captain chair hanging legs raises, planks, and legs drops as well as standing side crunches while holding a weight, she suggests.
2. Stray from spicy, acidic foods
When there’s too much food in your stomach, you up your risk for side stitches. “The main culprit is delayed digestion,” Sumbal says. Exercising spurs your metabolism, so it’s natural for digestion to be bogged down a bit pre-workout. “Limit foods that are fatty, acidic, and full of fiber 90 minutes before exercising,” she advises. Also be wary of concentrated shakes and bars; they can spell disaster for your gut—especially if you have a sensitive stomach—and contribute to stitches.
3. Complete a proper warmup
Obviously a proper warmup primes your muscles, boosts your range of motion, and increases your body temperature, but it also regulates your breathing patterns. “Allow up to 15 minutes to slowly increase blood flow, heart rate, and breathing,” Sumbal says. When you get your heart rate up, your lungs (and breath) will follow suit. But when you sprint from a dead start, your breathing becomes super-irregular and shallow, robbing your muscles of oxygen, essentially shocking your system. Really focus on your breathing; counting can help. Inhale for two counts, exhale for two. As your intensity increases, breathe in for two, breathe out for one. You’ll reduce spasms and stitches.
Perform dynamic exercises and consider breaking your warmup into intervals. Try 3×5-min runs with 1-min walk (as active rest) instead of a straight 15-minute running warmup, Sumbal suggests.
4. Practice pacing
Yes, pushing your body and upping the intensity is all part of getting faster. But if you’re constantly experiencing side cramps, pacing could be an issue—especially if you’re huffing and puffing and not getting adequate oxygen pumping through your body. When you’re sprinting, your breathing comes in short bursts, so it’s much harder for that oxygen to get to your muscles. To make up for this, try to build into the high intensities and allow enough time between intervals to actually catch your breath before plowing on to the next rep.
5. Change up your schedule
“Athletes can often be stubborn when it comes to issues with their bodies, hoping that if they keep working out, the issue will go away,” Sumbal says. “But you need to adjust what’s not working.” Reducing your risk of side stitches can be as simple as adjusting the time of day you work out, Sumbal says. If you’re running in the afternoon after lunch, consider running in the morning to reduce stress and possible irritants, or put more time between your last meal and workout. “Keep a log or consult with a professional if you feel your chronic stitches are not getting better,” Sumbal suggests.