What are they, and how can you get rid of them?

Whether you’re a seasoned marathoner or a recreational jogger, we all have one thing in common: we all get side stitches or side aches. If you’ve been around the block a few times, you may have mastered the technique of dealing with or hopefully preventing this uncomfortable pain on your own. If not, here’s a quick breakdown of the possible causes for side stitches and how to combat them.


With as common as side stitches are, you’d think there would be plenty of research about them. Unfortunately, that’s not the case, and what little research does exist is still largely unproven.

The leading theory is that the sharp pain right below your ribs is caused by muscle spasm. Your diaphragm, to be specific. It’s a dome-shaped sheet of muscle that extends along the bottom of your rib cage. It’s the main muscle that assists your breathing, which would explain why side aches occur during exercise, when your breathing may not be properly regulated. The idea is that, as a muscle, the diaphragm can become fatigued, just like any other muscle. But you can’t stop breathing, so it never gets a break! Since it must continue its job, it begins to cramp when it’s under too much stress, warning your body that it needs a break.

Another theory is that the impact from running causes your stomach and liver to pull down, away from the diaphragm, stretching the ligaments and periosteum, causing a sharp pain in your abdomen. This theory may be somewhat disputable, based on the fact that swimmers also experience side aches.


  1. Inverse breathing. This is my personal, tried-and-true method for dealing with side aches. As you breathe in, pull your stomach in, then as you breathe out, push your stomach out. I can’t promise scientific backing on this one, it was a tip my coach gave me when I ran in high school, and it’s carried me through many races since then. It may have been just the focus on regulating my breathing that helped so much, but either way—if it works, it works!
  2. Exhale as your left foot hits the ground. This comes from our second theory that your stomach and liver are pulling away, straining the ligaments. When you breathe out, your diaphragm contracts, pushing up towards your chest cavity. Conversely, when you run, each step causes a jarring impact, and gravity pulls your organs toward the ground. Since your diaphragm moves up and your liver and stomach move down (both located on your right side), the ligaments are put under stress. However, if you breathe out when your left foot hits the ground and breathe in on your right foot, both your diaphragm and organs would be moving down together, lessening the strain.



  1. Avoid fatty or high-fiber foods before you exercise. Food sloshing around in your stomach (making it heavier than usual) has been linked to the prevalence of side stitches. Stick to basic foods that don’t take long to digest or that will upset your stomach.
  2. Record what you eat. If you’re avoiding fatty and high-fiber foods, but it’s not getting you anywhere, it’s time to do a little research of your own. Record your pre-workout meals to see if anything is triggering that uncomfortable pang in your side. Start with what you typically eat, then change it around each workout to see if something specific is not agreeing with you. It may be one item, the amount of food, or even an entire food group.
  3. Watch your hydration. Dehydration is linked to muscle cramping, so make sure your body has adequate amounts of water for your activity.
  4. Practice “belly breathing.” Lie on your back and take a deep breath. If your chest lifts, your breathing is too shallow. Focus on making your stomach rise with each breath you take. This form of deep breathing allows enough oxygen to reach your muscles. It also gives your diaphragm time to fully lower. If you’re a shallow breather, your diaphragm will constantly be overtaxed. By allowing it to fully relax, you may avoid cramping.
  5. Practice tall posture. When your shoulders are hunched over, you shorten the space your diaphragm is able to move through, forcing shallow breathing.
  6. Warm up. Just like your legs need to warm up to avoid straining or pulling, your diaphragm needs time to adjust to a greater workload.
  7. Find a rhythm. Most runners typically breathe in on a even count, meaning they will breathe in for two, out for two. This rhythm will also move inline with your step count, so each time you inhale, the same foot will hit the ground, and consequently, the same will happen when you exhale. Try breathing in for two and out for three. Not only will this help you focus on your breathing, it’ll switch which side of your body feels the impact when you exhale.


Keep breathing!

iFit Trainer

Emily Wiley