What causes Stitches and Cramps during exercise

What Causes Stitches and Cramps During Exercise

If you are a runner or an athlete who spends most of his/her precious time working out or exercising, you might have come across or experienced stitches and cramps. Seriously, most runners go through the ordeal of suffering from side aches or side stitches one time or another while exercising.

Just imagine the kind of suffering you would have to go through because of the localized and sharp twinge of pain right below your rib cage, which often happens in the right lower abdomen. For runners, it is a common scenario and has been known to slow down certain athletes to an extend where they end up walking till the pain reduces.

Drastic Effects of Stitches and Cramps

Nowadays, research refer to the common and nagging pain in the abdominal by a scientific and technical term called as ‘Exercise-Related Transient Abdominal Pain (ETAP)’. Irrespective of what it is called or known, the pain is so severe that it often stops swimmers and runners right in their track and make them hold their sides in pain. So, whether you are a competitive athlete or recreational runner, having or you can say getting a stitch will surely make you stop your movement.

What is a Stitch?

Now before going into the detail of the factors affecting and causing stitches and how it can be prevented, you need to be aware of what it is. A stitch is a sharp pain felt in the abdomen (which is often at the side) and occurs due to constant sports or exercising activity. Now this can range from a stabbing or sharp to somewhat mild cramping, pulling or aching and might consist of pain in the shoulder tip.

It often leaves you with nothing but to slow down your steps or stop your running or exercising. Irrespective of whether you are right in the zone of the scenic running or you are almost going to reach the finish line of an important race, when stitches appear, it will be quite devastating and annoying for you. To deal with the stitch, you first need to know what causes this stitch and if there are any steps or measures to prevent one.

Facts About Stitches

  • Stitches are often common and involves in activities that are vigorous and quite upright repetitive in movement for the torso.
  • They often occur in any activities which consist of horse riding, swimming and even motorcycling.
  • It strikes commonly among one in five individuals who go for racing and sports events.
  • About 80% of any active individual who are under the age group of 20 will go through the medical problem called stitches and only 40-45% who are above the age of 40 experience it. It is quite rare for older people or kids below the age of 10.
  • The pain on the right side is two times more than the one in the left, and no one knows the reason for it.

There are many theories that suggest stitches are often caused due to the absences of the oxygen present in the diaphragm or due to the jiggling of the ligament that is connecting the abdominal organs. However, these theories have run out as there isn’t any hardcore evidence to support, which most specialists feel.

How Stitches Occur?

A side stitch will usually occur as a stabbing, aching, and sharp pain of the stomach, right below the ribs. This pain will be usually one sided and it will be followed by a sharp pain right at the tip of the shoulder at the same side.

Avoiding Side Stitch Triggering Food Items

There are few surveys which are simply based on studies conducted on runners and other athletes who suffer from side stitches right in athletic events on when they had a large meal or drank concentrated sugary liquids especially fruit juice just before the competition starts. These have a high chance of increasing the risk of getting stitches.

However, the studies also points out that if you are older and training for a long time (i.e. years) then it has less effects. In addition, novice runners are more likely to suffer from such stitches and if you are a new runner, then you need to track of the food that you are eating right before you go to the starting point.

Can Diaphragmatic Ischemia Cause Side Stitches?

One thing that you need to realize is that the actual cause of the side stitch is quite uncertain. Of course, there are some competing ideas, all of which have few evidences to prove them.

Previously, individuals assumed that ischemia or the decrease in the flow of the blood to the diaphragm (which is the muscle that expands the lungs and allows one to breathe) leads to the localized pain and irritation.

Now this is the major cause why some kind of fluids or food is quite prone to lead to side stitches, as a huge amount of blood is needed by the stomach for ensuring that the food is getting digested or else, liquids will pull out huge amount of blood from the diaphragm. However, there are various studies which show and provide the required evidences against such kind of diaphragmatic ischemia theory.

A study was conducted in the early 2000, where researchers measured the actual breathing patterns of athletes who were suffering from side stitches while exercising. For this study, twenty eight athletes were recruited and all of them had history of suffering from side stitches while training.

Also, various respiratory variables were measured that were associated with the functions of lung and breathing, which were intensively measured and then the athletes had to finish the run on the treadmill.

Out of the athletes recruited, fourteen of them got side stitch while others were easily able to finish the test without going through the pain. After this, as the test got over, athletes had their lung function measured again, and these were compared by the researchers with the functions of the pain-free sports individuals to the ones who were suffering from the side stitch. Here athletes who had side stitch showed a tiny reduction in the power of the lungs, especially during the exhalation, and this was concurred that the magnitude of difference was not going to affect the performance.

Now here you need to realize that the as they detected no kind of difference in the inhalation strength, which was basically due to the diaphragm, which simply means that the there was a poor flow of blood to the diaphragm and this wasn’t a major causal factor. In case, if it was indeed a great one, researchers would simply have expected to come across some kind of limitation in terms of strength or power of the diaphragm that is starved of blood.

You need to realize that the blood flow mustn’t be disrupted as a major part in terms of high impact but it can be for low-intensity sports like horseback riding and there are studies which show that side stitches can affect to about 60-65% of horse riders.

Abdominal Pain And Irritation Of The Ligaments

One of the another explanation for side stitches can be tugging or irritation that occurs on the ligaments and especially on the membrane which is holding and connecting all the various bones, muscles, and organs present in the abdomen. As per this theory, the impact that happens while the activity pulls the organ present in the abdomen downwards, it will even lead to the tugging of the ligaments present in the upper abdomen and will also lead to irritation.

Now this explains why one consumes a meal (irrespective of the contents) immediately before going for a run will lead to side stitch and it is also the major reason why side stitches is very much common among horse riders and runners but very rare for people who cycle.

But there are certain phenomena which won’t suit this theory too. And that is the fact that varying the concentration of sugars in the fluids which are consumed fast just before or while exercising will have a deep effect on the risk of having or leading to side stitch.

A study was done in 2004 where 40 athletes who had the history of side stitches while exercising were given a controlled amount of weakly flavored water, fruit juice, a sports drink and no fluids at all to each of the subjects. After having the required fluids, each of the subjects worked on the treadmill and reported if they had any kind of abdominal pain. Fruit juices which had the high concentration of sugar had the more chance of creating side stitch compared to other ones. Now the sports drink which contains medium concentration of sugar can cause medium amount of severe side stitches than the ones who consumed no fluids at all.

Another one is that side stitches will drastically affect up to about 75% of swimmers whose sports aren’t related to up-and-down jolting of the abdomen. So, it means that vertical tugging won’t or you can say can’t explain the original reasons for the side stitches.

Irritation Of Spinal Column

Another and one of the major reasons on how one can get stitches is the irritation of the spinal cord. A study which was conducted in the mid 2000s, about nine out of eighteen runners were tested to have suffering from side stitch which happened because they workout and also they applied extensive manual pressure on the vertebrae along the upper spine.

In addition, two separate studies were conducted which showed that kyphosis or the so called round back, which was a condition where the upper spine would be extensive and sharply curved compared to the normal one is because of the increase risk one suffers from side stitches.

Now here this spinal theory also shows that sometimes the pain which is prevalent right at the tip of the shoulder might be due to the nerve which runs right from the diaphragm and goes to the nerve which runs right from the tip of the shoulder that comes from the similar vertebrae. Furthermore, it even explains the reason why horse riders, runners, and even swimmers get high amount of side stitches while cyclist never do so.

Preventing Side Stitch

  • Have a lightweight breakfast which is extremely low in fat and fiber. You need to make sure that you have breakfast at least two to three hours before you start exercising or sports activities. Having a small power snack like banana is an exception.
  • Warming Up is necessary. Try to go for casual running or warm-up which not only builds muscles but even promotes optimal breathing.
  • You need to slowly increase your speed. Having a side stitch is a signal that your body is overwhelmed.

Causes Of Cramps

There are various reasons or theories that support or provide a detailed explanation on how one gets cramps while exercising.The most common one is the fatigue of the exercising muscles. This is the major reason on why cramps often happen in the muscle group which are directly involved while one is exercising.

Various research show that abnormal blood levels of magnesium, potassium, and even calcium will cause EAMC and even though most athletes suffer from the large losses of sodium while doing sports activities through sweat, there has been no rigid reason on how one gets cramps.

Reducing Cramps

  • The best and easiest way of reducing cramps is by training. It is a common knowledge that cramps is less common among athletes who are well trained and especially ones who are conditioned and ready for events they are training and competing for.
  • Another method is fuel up. Taking adequate amount of carbohydrates during and before exercising will avoid the chances of getting premature fatigue of muscles and even the risk of getting any kind of cramps.
  • Hydration is another method of reducing cramps, even though one can’t associate dehydration as the major cause for cramps.

In short, if you are really going through acute pains from stitches and cramps, you might need to consult your physician or doctor. Of course, you have the detailed information on how and when one might get stitches and cramps after reading this article, it is better to even consult your doctor before taking any preventive cure.


Saravavan Nadarajan (Vanan)

Vanan, fitness expert and leader at EzFit Singapore, specializes in holistic training—home-based, boot camps, and corporate fitness—with over a decade of industry experience.

You might also like