One thing first: as annoying and as painful a side stitch can be, it is harmless. At the same time, this phenomenon that primarily occurs in running has no real medical explanation because the exact causes are still not fully understood today. However, it is assumed that several factors encourage and cause a side stitch: 

Increased blood flow to the spleen

This causes the organ to swell, whereby the skin of the abdomen becomes stretched. This explanation, however, only seems to hold true when the side stitch occurs on the left-hand side. 

Reduced blood supply to the diaphragm

The diaphragm of the respiratory muscles becomes stressed by the prolonged physical exertion and the additional lack of oxygen can lead to a cramp-like pain. 

The connective tissues between the intestines and diaphragm become stretched after an abundant meal

Since athletes who train on an empty stomach also complain about side stitches, this reason is only partially plausible. However, it appears that an abundant intake of food and carbohydrate-rich and hypertonic drinks shortly before the sport have a negative impact on a side stitch. 

Jolting when running

The fact that runners are more often affected by side stitches than other athletes could be because intestinal gases move upwards due to the jolting. 

Change in tempo and rhythm

Many runners complain about side stitches during downhill passages. These not only require a change in the step rhythm but also in breathing. The constant change in pulse frequency can increasingly lead to side stitches, especially for beginners.

What are the possible ways to avoid a side stitch?

• In the first place, you should try to find out the circumstances under which the side stitch occurs. Perhaps you can detect an individual regularity that can be prevented in future. 
• Don’t consume any carbohydrate-rich and hypertonic drinks before the sport. Instead opt for isotonic sports drinks and still water in small amounts.
• Don’t do sports on a full stomach.
• Untrained people should avoid excessive increases in exertion and intensity, take a gradual approach to their training, and start slowly.
• Opt for continuous runs at a steady tempo and make sure your breathing pattern is regular.
• Strengthen your core muscles on a regular basis

What should you do when the pain comes?

• Decrease the level of intensity.
• Take a walking break or stop completely and breath in and out deeply with your stomach.
• Bend your upper body far forward, let your arms dangle downwards and breathe deeply and regularly at the same time. Tense your abdominal muscles.
• When you start running again, try to breath in and out at a constant step rhythm (for example, every three or four steps).

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