Side Stich - In the eyes of the runner

Every distance runner will have experienced that crippling shot in the side. Stabbing like a knife - But what to do?


I don’t believe it needs scientific proof or I am going to be shot down by some coach or runner in the outer world to contradict my facts. Every distance runner will have experienced that crippling shot in the side. Stabbing like a knife, being plunged just below the ribs as we try so hard to push on with our running goal. It could be training or racing but the predictability is incomprehensible. An elite moving from sub 5min miles to nearly a walk. Any runner, moving to a shuffle or walk and doing what they can do get rid of it. The exact cause of a side stitch is unknown. Some studies show that a movement of blood to the diaphragm or muscles during physical activity can lead to a side stitch. But other research shows that an irritation of the lining of the abdominal and pelvic cavity may be the cause. Evidence has suggested the blood shunting during exercise between the gut and the rest of the body is a possible cause.

Away from science. I am only going to discuss experience and possibilities. From eating too close to your run where the blood needed by the muscles is also needed to shunted to the gut to digest the food. Doesn’t really help Ultra runners who have to eat on their journey to give them some energy. A paradox!

A lack of electrolytes in the body. Often you will see white marks on your clothes after a run. This is proof of the loss of electrolytes such as sodium and potassium, in our sweat while we run. We fill up on water but also replace these simple minerals we need to help us retain the water and our body function efficiently.

There are suggestions it is to do with fitness. I find this really difficult to comprehend as it doesn’t explain the possibility of all the other factors and seems to leave a tag on those just starting to run or coming back from injury. An unfair tag. And yes one I have been given. Sometimes it can be our gait. We are leaning too far forward or back, in respect of our head position causing the muscles below to tense up and cause tension in our intercostal muscles and diaphragm.

When we are running hard and in oxygen debt we could be tensing up from our shoulders to our arm and core. It is a chain reaction. The reasons are complicated and inconclusive. That doesn’t help you deal with the stab that takes you from supreme flowing runner to a keeled over mess trying to shuffle along.

Our top tips to cope:

  • Pinching the skin just under the rib cage has always been a good suggestion. Often pinching and pulling the skin out may help with opening up the area and encouraging blood flow.
  • Another method is massaging the stomach and belly area pushing downward from the ribs to the waist.
  • Arching the back and pulling the shoulders back and opening up your posture is a method I have used.
  • Relaxing is crucial from your stride to your hands to your core. Drop your hands, relax your shoulders and just move along a little slowly but much more smoothly.
  • Deep breaths in through the nose and out through the mouth, slowing and deepening the breathing process can help at times.
  • Pausing for a moment and doing a side stretch may stretch out the tension and if push comes to shove, walk for a couple of minutes, get everything under control and relax could save so many minutes as you try to fight onward and it lasts longer.
  • Balanced and planned nutrition and hydration before and during your exercise

It is important to remember to test your nutrition before you run and not eat too close to your run especially if it is going to be an intense session. An Ultra runner will need to eat and drink on the move. Slowing down in these periods and also when you have to hike a hill. It is important to not overeat as this will just send too much blood to the gut. Eating little and often is a good guide. Just guzzling plain water on the run whatever the conditions will need to be reconsidered. As I have said you lose electrolytes in your running it is vital to ingest something with electrolytes. Energy drinks tend to be full of them. Tablets such as S-Caps that can be ingested with water, there are other tasteless varieties like Nuun or High.

You must train the gut like legs, core and whole body. They are not just my words. They come from Renee McGregor, internationally renowned sports nutritionist. The key, practice in training and this may alleviate problems in a race. Know your nutrition plan. It’s vital and crucial for a successful distance race or you are just throwing a dart blindfolded!

The stitch. I’m sorry it is here to stay, creeping up on us with its knife and stabbing us in the side. We may not know the complete reasons. But, we can be armed with the preventative methods and constructive possible solutions should we be caught out.

I can’t promise you won’t get one again as you move through your training, but what I can suggest is solutions I have tried and to a lesser or greater extent achieved success in dealing with them. The stitch – ‘you can do one!’

Nathan Montague

UK Head Coach The Running Klub

International Ultrarunner