Nothing ends an intense workout faster than a sudden, sharp, and almost debilitating pain on the side. This is the much dreaded side stitch, and it is a lot more common than you think.

The side stitch, more commonly known as exercise-related transient abdominal pain (ETAP), occurs as a cramp in your side near the rib area. More often than not, this happens when you run, though this has also been known to occur in other exercise activities, such as cycling, swimming, dancing, and even aerobics. The side stitch is so prevalent, in fact, that one in five racers gets them – and yes, even the most seasoned runners. It also happens more often in women rather than men. Furthermore, it is twice as likely to occur on the right side, instead of the left. It is also a lot more common among people below the age of 20.

Fortunately, the side stitch is not really serious, and tends to pass after just a few minutes. Still the question of why it occurs in the first place has been the subject of much discussion. Although the real cause of side stitches is still rather uncertain, there are several theories that have been touted by experts.

Diaphragmatic ischemia

In a nutshell, this means a decrease in blood flow to the diaphragm, which is the very muscle responsible for expanding your lungs and allowing you to breathe. Because of this lessened blood flow, therefore, localized pain and irritation occur.

According to an article by Dr. Lewis Maharam published in Runner’s World, the side stitch occurs as an effect of “dual pinching.” Basically, the pumping action of the legs puts pressure on the diaphragm from below, while rapid breathing expands the lungs, putting pressure on the muscle from above – essentially creating a sort of vise that shuts off the flow of oxygen and blood to the diaphragm, which inevitably causes the stitch.

Irritation on the ligaments

Another purported theory as to the cause of the side stitch is the “tugging” on the ligaments – that is to say, the membrane that connects all the bones, organs, and muscles in the abdominal area. As you perform exercises, you breathe in and out frequently, stretching the ligaments in the process and causing pain. Basically, the organs in your abdomen are pulled downwards in the impact generated during activity, tugging on the ligaments and causing the very irritating side stitch.

Consumption prior to activity

Experts have observed that certain food and fluids consumed prior to exercise are actually more prone to cause side stitches than others. This is because the stomach requires more blood to digest certain food items, pulling blood away from the diaphragm that needs it more.

Fatty food, in particular, seems to be particularly predisposed. Ditto with sugary drinks. However, people normally do not consume fatty food prior to working out, so sugar does seem to be the bigger culprit and does, in fact, have a measurable effect on a person’s risk to developing a stitch.


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