What the heck causes that STITCH in the side?

Causes for that stitch in your side when your run - Fitness Revolution RowlettThat damn stitch just hurts! If you’re reading this then you have had one before and you can understand that you can only fight it for so long before eventually it causes you to slow down or stop before you in agonizing pain just trying to catch your breath.

I see this more common during the summer months when people are attempting to do more HIIT cardio to drop body fat but what ends up halting their running is they begin to get that stitch in their sides. After the person spends a few minutes catching their breath I tend to get the question why does this happen?

Feels a bit defeating trying to get your sexy on when your body is just saying NO lol


What causes it?

Honestly science has dug into this and there are many theories but no definitive answer :-/ One theory that I’m personally a little more incline to believe is that this “stitch” we feel is  (1) “Excess tension in the ligaments of the diaphragm due to the vibrations they undergo when we are running or doing some other type of physical activity.”

Diaphragm spasms cause that stitch in the side - Fitness Revolution Rowlett

Get ready for a bit of nerd here:

Quick anatomy lesson here is that the Diaphragm is a dome shaped muscle in the body that separates the heart lungs and ribs from the rest of the abdominal cavity; in addition it is also responsible for assistance in breathing. During inhalation, the diaphragm contracts, thus enlarging the volume of space where the lungs are located allowing more room for the lungs to expand for us to take in more air during our workouts.

(2) “The jarring motion of running while breathing in and out stretches these ligaments. Runners tend to exhale every two or four steps. Most people exhale as the left foot hits the ground, but some people exhale when the right foot hits the ground. It is the later group who seem more prone to get side stitches.”

(2) “Exhaling when the right foot hits the ground causes greater forces on the liver (which is on the right side just below the rib cage). So, just as the liver is dropping down the diaphragm raises for the exhalation. It is believed this repeated stretching leads to spasms in the diaphragm.”

So other words guys, this means that the ligaments of the diaphragm muscle are getting too stretched out and tired during bouts of intense exercise that they are starting to give out thus causing the pain or “stitch” in our sides.


The way I see it

My theory that I’ve always explained to clients is that this stitch we are feeling is an accessory breathing muscle (diaphragm or intercostals) that can’t keep up with the demand you are placing on it and thus it’s getting a lactic acid burn, just like any other muscle when worked out. When you work out your legs and you are placing a large demand on them eventually you will feel the “burn” and eventually your legs will begin to shut down. The diaphragm is a muscle and follows the same physiological guidelines as any other muscle in the body. So the above theory does make a bit of sense.

Side note: The one thing that I find interesting is that the weight of the liver alone during bouts of exercise can cause further strain on the diaphragm’s ligaments in conjunction to exhaling on the right foot drop which just stretches the ligaments even further.


What to do if you get one

  • Slow down your intensity to match your fitness level (don’t worry as you get fitter you’ll build it up)
  • Take deep breaths, this allows the diaphragm to relax and drop a bit further down the body giving momentary relief to the ligaments.
  • Stretch. Since the area is over active and probably spasming or tremoring then the quickest way to help it turn off is to raise your arm (on the side of the stitch) straight up and lean towards the opposite direction. Hold for 30 seconds, release, and then stretch the other side.
  • Press your thumb into the painful area and help massage it out.
  • IF you are feeling this while running trying changing up your exhalation pattern, instead of exhaling when the right food hits try the exhaling when the left foot hits.


This all comes down to conditioning level, as you get fitter the likely hood of this happening lessons over time. So just accept that that is part of the sexy race we are all on and know that it DOES get easier and YOU WILL get better.




1. http://sportize.me/blog-deporte-fitness/2012/02/11/help-ive-got-stitch

2. http://sportsmedicine.about.com/cs/injuries/a/aa053100a.htm



In Health and Awesomeness,

Travis Signature 300x62 Your Excuse is Invalid

Travis Merritt, BS, CPT, CES, RBT is the owner of Fitness Revolution in Rowlett, TX.

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