Side Stitches/Cramps and Running

There is actually quite a bit written about side cramps or stitches (these terms are used interchangeably). It is a cramping of the abdominal muscles – diaphragm. Most often it is on the right side but most definitely it can be on the left or both sides. You may even get a deferred pain in your shoulder due to nerve connections. (Note: I’m avoiding technical anatomical descriptions purposely.)

First, the huge consensus is that a more novice runner or an out of shape returning runner are by far the most likely to experience a stitch.

Second, stitches can often be traced to faulty breathing.

Third, and related to the first two, is running downhill (and occasionally uphill). Because we alter our body alignment or posture, we stress those abdominal and respiratory muscles differently. We are not in shape for this type of running.

Mostly, it is related most often to a newer runner or someone out of shape, or someone pushing themselves to higher levels (or on new terrain) than they have prepared for in training. In each case, your breathing becomes increasingly relied on to supply your body with oxygen due to the work load. The work load is relative so it makes sense in each case that these people are most susceptible to side cramping.

Prevention & Cures for Stitches

At the foundation of ridding yourself of stitches is progressively getting in better shape. As your diaphragm and intercostal muscles get more exercise they begin to accommodate to heavier breathing for longer periods of time. These muscles are in no different situation than your leg muscles for running; they have to be conditioned.

Here’s a breathing-specific training tool. Here is one option to isolate the respiratory system muscles – the Power-Breathe exerciser. (Nope, I have no financial gain in this referral unfortunately.) It is clinically used for asthmatics and sufferers of COPD and other respiratory diseases specifically to strenthen breathing muscles. They have athlete adapted apparatus as well. I have tried this contraption out. It’s simple, small & portable, under $75 and it indeed does give your breathing muscles a workout.

Learn to belly-breathe. Your stomach should move out as you inhale. If it moves in as your chest moves out, it puts added stretch on that diaphragm and can induce those stitches.

As for those hills as a cause, most basically simply get in shape for running hills. The stitch is most likely related to changing your running biomechanics – leaning back and breaking on the downhills. It can be countered by running more naturally, letting go a bit and not breaking so much (without going wild). Uphills refrain from leaning over too much from the waist – run more upright (but not straight as an arrow). In both cases, the best cure is prevention. Train on hilly terrain similar to what you will race on. Of course, you also have to run at similar paces or it will not get you ready for those uphills or downhills. Hard repeats on hills (up and/or down) is a good training element to introduce to your routine.

Though there is no solid research supporting this I agree with conventional wisdom and strongly recommend that you do both abdominal strengthening and stretching as part of your workout routine. It will enhance strength and the range of motion of the muscles.

Correcting your breathing is the next focus. Some “experts” profess some magical formulas like 2:2 breathing (2 steps inhale, 2 steps exhale). They cite some research that found similar patterns in elite runners. This pattern is a result of being in condition and breathing at the rate which supplies enough oxygen to your body to move at a given pace. It is not: breathing at this pattern makes you faster and more efficient to run at the given pace and therefore have less stitches. These are Tail-wagging-the-dog theorists. They have taken correlational data and made it into a cause-and-effect – the wrong one at that! The reason elite athletes do not suffer very often from a side cramp is because they are in shape! It is not because of breathing some arbitrary pattern.

Once you get a stitch – slow slightly and purse your lips on exhaling and forcefully exhale. It provides an exaggerated exhalation and tension on those respiratory muscles which may relieve that stitch. Repeat this several times.

Another technique is to put your hands on your sides and apply pressure to the area of the stitch as you breath. Sometimes bending forward slightly with pressure from your fingers in the area will help relieve it as well.

Ancecdotally, when I workout and do sit-ups or abdominal crunches I have found a pattern of getting stitches the next time I run. I’m sure the connection is that it affected tightnessor fatigue in my diaphragm or ancillary respiratory muscles and so I got a cramp when I went out trying to breathe in that “running” way.

Sometimes curing a stitch is like stopping the hiccups – there are as many home solutions and cures as there are people. So, how about you, what have you found to be effective to stop getting stitches?


About Dean Hebert

I’m a mental game coach, author and speaker. I work with individual athletes, parents, coaches, and teams on sports performance enhancement. Beyond my academic post-graduate work in sports psychology - the psychology behind athlete performance – I am a certified Mental Games Coaching Professional (MGCP) and certified hypnotherapist. I’ve authored several books and hundreds of articles. “Coach, I didn’t run because…” (2008) is a seriously light-hearted look at making excuses not to workout and how to overcome them. “Focus for Fitness” (2009) and “Screw the Goals Give me the Donut” (2010) are two of my eBooks on mental game approaches for the everyday athlete. I wrote these because I believe that everyone can benefit from the powerful mental techniques that the world’s best athletes use. I have been cited in Runners World, Best Health magazine (CN), SWEAT Magazine, and the Washington Examiner amongst many other publications. I have been a featured mental games coach in Runner’s World and for the internationally acclaimed trail running resource - I also regularly appear on sports and fitness talk shows such as LTKFitness, Runnersroundtable and for more than three years I have co-hosted a weekly video series with Coach Joe English for I specialize in mental toughness training. My clients include tennis, synchronized swimming, golf, race-kart, soccer, motocross, volleyball, MMA, cycling (road, off-road, time-trialist), running, duathlon and triathlon, basketball, football and baseball athletes. I have coached world-class athletes and athletes internationally. I have a passion for working with youth athletes and helping them apply mental game skills and techniques to all areas of life. Most importantly, my aim is to have people enjoy sports and life to their fullest through peak performances.
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118 Responses to Side Stitches/Cramps and Running

  1. dabigleap says:

    Hey coach,

    I seem to get them when I push really hard during a run (above target pace) and have found the best way to resolve them is to belly breathe or take a real hard, forceful inhale (greater than normal) or two. And definitely, as I have gotten in better shape, they have decreased in length and intensity. Great post!

  2. Pingback: Running, running & running, running « Joyce’s Brain Chatter

  3. ANDREW says:

    Been spending the last few months on a treadmill doing 3-5 miles at a time & obtaining my personal best 1 mile time. Ive been very competitive with myself. Today I ran outside on somewhat hilly terrain and was horrible! Cramping to the point of having to stop. I also experienced a tightening/cramping in my back (laterals) Have you ever heard of this. Great comprehensive post coach!

  4. Ok,
    Well you experienced what does indeed happen … if you change training terrain it can indeed cause cramping. I have had some runners with lower back cramping as well but usually with higher speed track work. The common element though is that you change body postures over varying terrains. That causes your muscles (not just abdominal or diaghragm) to work differently. Any muscles not used and developed can become overused in this scenario and cramp.

    Gradually go from one terrain or surface to another. Sudden changes will precipitate cramping. Simulate hills on your treadmill… use varying inclines to help with the transition. If yo haven’t been working core muscle groups… you’ll want to do that also.

    I think you’ll be fine… just make gradual transitions. My hat’s off to you that you’re donig lots of tread training… it’s mentally fatiguing. Keep up the good work!
    Coach Dean

    • DesperateRunner says:

      I’m a really in shape person and I started doing cross country, and I was easily doing the runs. Then two and a half weeks later one day, I drank too much water, ran up a hill too fast and wasn’t breathing properly. Based on this I was basically setting myself up for a cramp. However we still had about three quarters of a mile and I didn’t want to stop. The result of this was the worst cramp I’ve ever had in my life. I was in pain for about three days, but as soon as it started going away I decided to start running again. But less than ten minutes into the run I’d felt it. This has been going on for over two weeks and I cant even run the half mile warmup without the pain. Any suggestions for a cramp that has lasted more than too weeks?

      • Dean Hebert says:

        Your situation is not completely unheard of. A severe cramp episode can indeed last and be recurrent. There is no secret pill to make it go away. Try many of the suggestions – deep breathing, holding your breath, pursed lip exhalations all exercise and stretch out your abdominal muscles. Start runs slower and see if rhythmic, slower breathing at slower paces slowly warm-up the muscles to that it can take the harder paces. Perform much more thorough warm-ups. Stretch your core & abs in the evenings or when you are just sitting around. Good luck with this… it will eventually go away.

  5. Kristin says:

    Thanks so much for the article…I have a question, I have been running 3-5x a week for 5 months now, and just recently I have been getting cramps under my entire ribcage. It usually lasts for my first mile, and a little down hill, but eventually goes away. I have tried regulating my breathing and I always try to “belly-breath” but the problem is still occurring. Could it also be caused by drinking too much water before my runs?


  6. First – yes fluids or food on your stomach can indeed cause cramping. The excess expansion of your stomach (it doesn’t have to be much and it varies widely form person to person) causes your diaphragm to contract differently.
    Second – downhill running can often causes cramping.
    Third – if your pace downhill is slightly faster than usual and causing you to breath harder or differently than otherwise, it may be the cause of cramping.

    Solutions: Well, first as you get in better condition over time hopefully they will subside. The fact that it goes away AFTER the downhill leads me to suspect the issue is more getting used to the downhill running. Don’t lean back too much going downhill. Let go a bit and let gravity take you more naturally down. Now the possible down side is that you will run slightly faster (instead of holding back) and that in itself may give you cramps. Definitely decrease fluids before your run… take some in 20-30 minutes before you run. Unless you are in very hot climates and run more than 30 minutes or so, you really don’t need to be tanking up on fluids before you run. Get them in you immediately afterwards instead. (I’m not saying abstain from drinking… just lay off in that 30-60 minutes before a run.)
    Tell me how it goes.
    Coach Dean

  7. Charity says:

    Ugh, I had this problem this morning. I run every day and normally don’t have a major problem with cramps. But this morning I only got to about two miles when I got cramps so bad in my right side that I couldn’t continue. I could have finished my run pressing into my side for the duration, but that seemed a nuisance. I’m not sure what I did wrong….I’m not out of shape, I was not running any exaggerated hills or too fast…..basically, I was just doing an “easy” run but “bam!!” The worst stitches I’ve had in months. I think you’re right about the abdominal exercises as my trainer had me do a new ab workout that left by obliques very sore. It must be related. Thanks for your article!!

  8. Interesting that pressing into your side helped. That is often reported. When you put pressure on your side you are in effect stretching out that muscle… much like with massaging muscles.

    You might try abdominal stretches after those hard ab workouts. That way, you leave them stretched out instead of contracted or tense from the exercising. I’d recommend using an exercise ball and lay your back on it and slowly roll backward stretching out your abs as you do.
    Coach Dean

  9. Natalie says:

    I have a question. I have been training for about 8 months now for a half marathon. I used to be a runner in high school, so my body is fairly used to running, but it’s been a while, so I’m taking my time getting into marathon shape. Anyway, I usually don’t get these stitches, but when I do they usually occur during a harder run and last for days. If I take a day off then it may heal in two days, but if I keep training, they won’t go away. I have had one now for four days and I’m beginning to get frustrated. I was running between 5-8 miles 4-6 days a week and was doing just fine, but now I’ve cut back to just 2 miles and I barely make it to a quarter mile before I get this pain. It’s on my right side, just beneath my rib cage. It helps to press on it, but it’s hard to run and hold my hand there the whole time. I try the belly breathing and when I exhale it feels good, but as soon as I take air in it hurts extremely bad and I have to stop after a mile or two. Today I only made it to a mile and couldn’t stand up straight. I tried stretching it out today before, but that didn’t seem to help. I do abs about three times a week, so maybe they are just too tight, but I’m afraid my body won’t let me get any faster or something. Anyway, just wondering if the problem is over exercise, or going to fast, or could it possibly be diet? Can taking in not enough calories, or not enough of a particular food make this happen? Does eating pasta help? I can’t think of anything else to do other than stop running, but I want to get better and faster.

  10. Dean Hebert says:

    You don’t say how long it’s been since those high school days but remember – DEtraining takes place pretty rapidly. So, if it’s been a few years – even if you’ve been pretty active – you’re in starting over mode.

    Think of that side cramp as as cramping muscle. As stated before the #1 issue is conditioning. Be patient… for most runners… most of the time… they subside.

    Ok, that doesn’t help today. So, I would recommend a good abdominal strengthening AND stretching program. It is obviously your “Achilles Heel”. The fact that holding your abs helps tells me that indeed you have a traditional side cramp. The #1 cause is conditioning.

    I thoroughly doubt it is of diet origins… not that it is impossible, but unlikely. If it is due to diet., then ALL muscles or at least many different muscles may be getting similar symptoms.

    Though I am an advocate of quality over quantity… in your case perhaps for now… slow down.. get runs done .. even if slower than usual. Overall you’ll get some progress. That is better than having so many days off that you lose conditioning.

    Run until you feel a cramp coming on then STOP. WALK. Then run again. Each time you feel it coming… and yet BEFORE it really happens… stop and walk. Do this continuously. The goal is that you’ll gradually extend the distance and “condition” those breathing muscles.

    One other tactic that I have known to help, but I have to admit I do not have research evidence to support it (which I am always bias to over anecdotal evidence); take a couple of aspirin/tylenol/ibuprofen 30 minutes or so before you run. It may help alleviate the discomfort and allow you to work through it better. (If you area susceptible to stomach upset these are not viable options.)

    Hang in there… work through this… you can make it. Stay in touch and tell me how it goes.

  11. Natalie says:

    Okay, thanks Dean for all your help! I will keep in touch and let you know how it goes. I know this will be hard because every time I have to slow my pace down I feel really slow and discouraged that I’m a slow runner. I graduated high school in 2003, and during that last year I was building back up after having been through kidney failure. I took time off running (during college aside from one year on the crew team) up until 8 months ago. In addition to running I’m doing weight lifting 4 days a week.

    So, I have another question. Perhaps you may not know the answer… probably no one does. In high school I ran a 25 minute 5k (I know really slow), but I think I could have been faster because I wasn’t doing any strength training and had pretty poor nutrition that really took a toll on my running. My goal is to reach a 21 minute 5k, but I’m not even sure if that is in the cards for me. Do you think it’s possible, with the right training for me to get that fit, or fast? If not, how do I keep from getting discouraged about being a slow runner. I love running, but I’m very competitive, and feel defeated. Perhaps, I just need to let go of the dream of being a fast long distance runner. What do you think?

    And also, do you know how long (approximately) it takes for someone to get back into shape? I know it probably depends on the person, but I’ve been weight lifting (which I had never done before) and running and I’m discouraged by how far I have come… I know I have made improvements, but I thought I would have met my 5k time by now. Does this kind of thing take years?

    I’m not sure if I’ve made much sense, but I’m not sure who to ask these questions, and you seem to be patient and friendly!


  12. Dean Hebert says:

    Such a great question… check out a new blog article on this today or tomorrow!

  13. Kyle says:

    Hello Dean,

    This website is very informative and helpful as I think I am starting to understand what is going on. I’m starting to push my running very heavily for cross country training and it seems I seem to get these “stiches/cramps” quite often halfway or 3/4 through the intense run. This only happens when I put myself hard and sometimes the stich spreads all throughout my right side, including chest and obliques. I was wondering if you had any other suggestsion besides what I read up top or possibly this could be another problem.

    Thanks, Kyle

  14. Dean Hebert says:

    You have a more classic pattern that indicates a conditioning issue. Since you mention cross country, this also means some hills and varying terrain – which as mentioned contributes to side cramps. Since it is late in the run and at an intense pace I would try a couple things.

    First, slow down BEFORE it occurs… when you just get that hint that it is coming on. Relax, recover a bit… then see if you can launch back into your intense pace. You’ll be training your muscles to work at that pace over a longer period of time – albeit not continuous. Gradually, with conditioning you should be able to decrease that “backing off” time and do it all as one continuous hard run.

    Second, as I mention above to one post:
    “One other tactic that I have known to help, but I have to admit I do not have research evidence to support it (which I am always bias to over anecdotal evidence); take a couple of aspirin/tylenol/ibuprofen 30 minutes or so before you run. It may help alleviate the discomfort and allow you to work through it better. (If you area susceptible to stomach upset these are not viable options.)”

    The key will be to be proactive and stop the cramping before it occurs. Once it occurs it is always harder to get rid of.

    Tell me how it goes.

  15. Kyle says:

    Ah thank you for the advice, but I have to mention that during one of my races was around 6k (The whole race was flat terrain) at around half way I started the side cramping and I still pulled through the other half at a decent pace. As soon as I stopped running the cramping stopped. I would of thought it would stay since I was pushing it so hard for at least 3km.

    Anyways I will try your advice and continue to also do some abdominal exercises/stretching in those areas to hopefully eliminate this problem.

  16. Juana says:

    What other factors contribute to getting side stitches? I recently began getting them every time I run (1.5 weeks) just a little after my first mile. I have not changed my route or intensity, I have tried breathing in more deeply, breathing out when my left foot hits the ground, drinking water 20 min before I run, not drinking water before I run, stretching my abdomen ……. The only thing that has changed is the temperature outside. Might the climate have something to do with my side stitches or could it be something else?

  17. Dean Hebert says:

    For a the relatively short distance of 1.5 miles, avoid fluids at all for even a longer period before you run. Dehydration is a non-existent issue at that distance.

    I do not know of any weather related reasons for stitches.

    I don’t know what condition you are in but my thoughts go more towards a conditioning issue if 1.5 miles is your average or long run. Extending your runs and doing faster runs will enhance your condition and decrease incidents of stitches.

    If your stomach can handle it, try the couple aspirin or ibuprofen prior to running.

    If you have changed any other training routine – new exercises, new stretches, etc. – that could be the cause also.

  18. David says:

    Hello Coach, I’m a 15 year boy who has had weight problems in the last few years. In the last 8-12 months ive lost approximately 63 pounds and have always wanted to do cross country. All of my friends are on the team and tell me how much fun it is and I really wanna do it to prove to myself that i have made a difference. When i run I get these stiches in my side after about a tenth of a mile, by the way my first tenth of a mile is a downhill angle of around 30-40 degrees and pretty steep. I have stopped drinking all carbination, I dont drink or eat anything before i run for at least an hour, and these stiches are really the only thing stopping me from running alot farther of distances.

  19. Dean Hebert says:

    First congratulations on losing weight and choosing a healthy direction… not easy to do but you’re doing it!

    Two things are most likely at play here: that pesky downhill and general conditioning. You don’t say if the stitch stays with you or eventually goes away or if it only happens when running this one course with the downhill. So, it it is primarily on this course, the first thing to do is make sure you warm up well before running down. Second, how about just making that downhill a walk and part of your warm up? It’s only a tenth of a mile…

    Second, if you can keep the stitches at bay so that you can get out and do more running without being impeded by the cramp, the faster you will get into shape.

    Your friends are right about cross-country by the way. Unlike track I found it far more fun with just one “event” as the focus and everyone doing the same thing. And better yet… everyone can go out for cross country. I love the all-inclusive nature of the sport. And as far as individual efforts go, it’s something you can measure you progress all along the way. The only real limitation is the amount of personal effort you put into it.

    Hang in there… over time those stitches should decrease. See some of the other general suggestions in this whole thread too.

    Thanks for reading! Drop a line on your progress.

  20. Whitney says:

    Thanks for the site, very useful. I am a D1 tennis player, and obviously train very hard. I’m in the weight room every day, 2-3 hours of tennis everyday, and very high intensity conditioning 3 times a week (typically I burn about 350-400 calories in a 30 minute treadmill workout). Long distance running has never been my thing, unfortunately. I have ALWAYS had trouble with side cramps, but I know it’s not due to being out of shape. It’s typically only in long distance running that I have this problem, I have never run into it while doing sprints or while playing tennis. Anyways, it has really been bothering me the past couple of weeks, to the point where I can’t finish workouts. Some other things that come along with my side cramps are tightness of my chest ( I think it may be more of a very deep cramp down in my rib cage), as well as a very uncomfortable feeling (almost a cramp) in my upper back area, it feels like its behind my left shoulder blade. I was just wondering if you have ever heard of posture possibly affecting these types of cramps, or if you had any other thoughts? Thanks!!

  21. Pingback: Side Stitches Revisited « The Running World According to Dean

  22. Annie says:

    I get stitches unpredictably even when I’m in shape after a seasons worth of running. I’m not convinced that I’m breathing incorrectly because they would occur more often.

  23. Dean Hebert says:

    You may be right. So, the first thing to do is to look at all other patterns – eating, time of day, terrain, run effort, pace, hydration status, medicines/prescriptions, etc. You may find something that ties the unpredictability together. On the other hand, sometimes a single cause is not to be found. When it is not linked to something, somewhere, some how, it is very frustrating. I wish I had a better answer.

  24. Nicole says:

    I’ve just starting training for a marathon, and I think I am experiencing the “deferred pain” in the right shoulder. I should mention that this is my first race ever, and I wasn’t ever a runner. Right now we’re just at 5 miles a day, and I do okay keeping up with it. We’re running through neighborhoods, and they get slightly hilly, but I notice the pain at various points of my run. The pain is like a jabbing but numbing pain and it seems like it travels through my tricep down towards my elbow. I’ve tried rubbing my shoulder and I try to keep it lose while running, and I even stretch/swing my arm around while mid-stride, but that one just hurts it more. The pain also comes and goes. About 5 minutes after my run my arm is totally fine, thank goodness.

    Now that I’ve read from your site (and a few others) that it could be messed up nerve connections, and that the pain is actually my diaphragm, my question is do you have any suggestions on alleviating it in the short term? I completely understand that with training/conditioning my muscles should get used to this work, but I don’t have any cramp near my diaphragm to press on at the moment, and I don’t think I want to try the aspirin/advil route. Such a weird phenomenon, but I’m so glad to find out it’s sort of normal! Is there any term to describe it so that I can go read more technical details, just to satisfy my own curiosity =)

    Thank you so much for your site, it’s so very appreciated!

  25. Dean Hebert says:

    I have to admit I have not heard of the pain moving down the arm. I’m glad it subsides after a few minutes. I am not one to jump to the ridiculous but I want to share one thought: you may want a stress test done by a cardiologist. Women experience heart related ailments differently than men, and I have personal experiences that bare this out.

    Given that one thought, in the interim it would appear that conditioning is the most likely cause since you are just beginning. Since it does go away after warming up and moving along a bit I would try to do longer warm-ups that include both stretching and strengthening your diaphragm/abs/core. Side to side stretches, sit-ups or crunches, core (the plank) exercises might be things to work into that warm-up. The goal is to get all those muscles warmed up similarly to after the 5 minutes you usually find relief.

    I don’t think I’ve ever come across a medical term for this deferred pain. Maybe we could coin a phrase for it!

  26. Nicole says:


    I wouldn’t want to drop dead in the middle of a run, but I am only 25 and not overweight. Do you think at this age I might still need to see a cardiologist?

  27. Dean Hebert says:

    Of course I’m not a doctor. My most vivid experience is actually a blog post

    Claudia was in her early 40s; 5-4 115 pounds soaking wet; no risk factors; no history of heart disease in her family; a highly competitive runner since high school – almost 30 years running experience; represented the US in the World Duathlon championships only 10 years ago; is a masters All-American in multiple events… had a heart attack.

    So, I am not an alarmist, but I did want to share that the pain you experience is not typical. That does not mean that it is anything other than deferred pain from the diaphragm. But, I would be remiss if i didn’t introduce other possibilities.

  28. Alex says:

    Hi, Thanks for this useful site. I have been running for several years and for the past several months approximately 20 or so miles a week. I have never had issues with stitches except for the last 4 weeks at the tail end of my long run (10 miles). It is always around the same time (9.67 miles), where I have to run a long downhill, and it is usually after having second gel pack (which doesn’t cause any issues the first time). It feels like a bubble in my right side that starts to move over my belly button and causes such pain that I have to stop, double over and can barely finish running. I wonder if I should just skip the 2nd gel? Can’t tell if I’m getting too much fluid or not enough. It has been extremely hot and humid, I generally take a small swig of coconut water every 10 min or so but continue to feel thirsty. I do have asthma and although I’m on practically every inhaler under the sun, my asthma is not always well controlled so I tend to breathe heavily especially on hill ascents and descents. I try putting my hands above my head (no help), to slow down (no help). Any thoughts you have are welcome. Thanks.

  29. Dean Hebert says:

    Thanks for your inquiry. Please see the post on 8/16/09 for further discussion on this topic.

  30. Jacob says:

    hey. Im a junior in high school and run on the varsity cross country team. I ran my first race two weeks ago and did great with a 20 second PR of 17:19 in a 5k. This race was on a extremely flat course. Then a few days ago i ran a race witch i have ran three different times. Every time i run it i get a terrible side ache in the same spot on the course. Its just after the second mile and down a huge hill.

    I seem to only get side aches after or during the down hills when in races. It is significantly making my times really bad on these hilly courses. Do you know why this is and what i can do?

  31. Dean Hebert says:

    Within your reply is in fact your answers. Steep downhills are notorious for causing side cramps. Your pattern is unmistakable.

    In your case you are in very good general condition and your times show it. So what remains is DOWNHILL conditioning. Downhill running is not a passive thing… it isn’t some natural activity that we all do well or fast. If it isn’t practiced you will suffer for it.

    Run repeats downhill at top and near speed (this will also serve as overspeed training which is excellent).
    Focus on relaxing your upper body – don’t flail your arms all over the place.
    Run erect and do not lean backwards giving a sort of braking effect to your running.
    Allow gravity to take you. You should be able to run quite fast without the effort. But, it requires very fast leg turnover to become smooth.
    Don’t take huge overstriding strides… strive for faster moderate length strides (though certainly they will be longer than on flat ground).

    A couple weeks of practicing downhills 2-3 times per week should greatly reduce your incidence of cramping.

  32. Maria says:

    Im a freshman in highschool, and I’ve been running on my own nearly every day even before track season, but lately ive been getting bad pains directly below my rib cage. They start almost immediately when i begin a run, and continue for at least half an hour. Only at the end of runs do they go away eventually. Its a bad pain that feels like a lot of pressure underneath my ribs, all along.
    I eat a light lunch 2-3 hours before i run, and I have tried stretching my sides but since it is not my side that hurts I dont think stretching it will be of much use. I heard drinking plenty of water throughout the day, just not directly before the run, will help. what should i do?

    • Dean Hebert says:

      Youth and high school runners are very prone to this problem The number one reason is conditioning, once we rule out eating and drinking too soon before running. It appears we can indeed rule those out for you.

      So, some things to consider:
      Has this ever happened before or is this new? If it happened before, do what you did to get rid of them. If not…
      Are you now running farther or faster than you have done before? If so, it is definitely a conditioning issue.
      And, have you gone through a growth spurt? When you body changes, your form changes, your muscles are trying to catch up with your bones and so it may just be “time” before your whole body settles down.
      Has your form changed? If you lean too far forward, this will often cause cramps.

      And some things to do:
      Strengthen your abdominal muscles; sit-ups, leg lifts, Planks.
      Stretch your abdominal muscles: if you are flexible do standing back-overs, hold for 15 seconds then let go. Do several of these in conjunction with strengthening – do not do just one or the other.
      Overall body strengthening will also help.

      Tell me how it goes. Be patient. Side cramps tend not to go away immediately. Keep at it.

  33. Yakuta says:

    Hey coach Dean,

    I stumbled upon this website because i obviously have a similar problem. I read through all the comments and the advices that you have given these people, however it did not answer the question i had. I am a fit 21 year old girl and i love to run.. i have been running 5 miles every other day.. May i add that i take breaks between my runnings.. However, just 2 days back, i started to run and i got the stitch and i stopped running and started back up again after a minute and 30 seconds… When i got home, i still had that weird pain you get when you have the stitch although it was not as sharp.. it just hurts when i move in specific ways.. I am afraid that it won’t go away.. I have had the stitch now for almost 2 days..Could you possibly have some kind of remedy or suggestion as to what i could do to get rid of it.. ?? Thank you so much

    • Dean Hebert says:

      This is uncommon BUT I’ve heard of it before. I’ve also experienced a side stitch which seemed to persist through multiple runs.
      There is no complete cure or remedy (ok that is the bad news).

      BUT, all previous comments still apply. Do the exercises, do belly breathing and you have to persist to get in better shape so that the cramps do not occur or recur.

      One other technique worth trying. Do speed-strength workouts. Hard 400 meters (one lap of a track) and then immediately go into the following exercises – sit-ups, push-ups, squats. I find that by doing the sit-ups immediately after breathing hard on the 400 i specifically exercise those breathing muscles. With each sit-up exhale with force contracting those abdominal muscles. Do the sit-ups rapidly. 10-20 at a minimum. Then move on to the other exercises… then immediately go into your next 400. Do not linger or “catch your breath”. That is the key to this workout’s effectiveness. Start with 4-6 400s and progress to as many as 8 over a 6-8 week period.

      Good luck.

  34. Mark says:

    I have heard that you should always drink Gatorade or any sport drink 30min or an hour before practice but i have found after drinking all of bottle of sport drink to give a cramp. Then having a gulp or a sip in that time frame didn’t give me any pains.

  35. Dean Hebert says:

    The key here is the AMOUNT and not the type of drink. But that being said, water is lighter on your stomach than a commercial drink – which might help.

    First – drink less…. NOT a whole container of the drink.
    Second – switch to water… you are not running far enough to worry about replacing anything BEFORE a workout. Save it for AFTER the workout.
    Third – stay hydrated all day long so that you have less of a need to drink much BEFORE the workout.
    Fourth – when you do drink during workouts.. just a couple gulps is good enough. Our workouts aren’t that long to worry about this.

  36. Aman Kataria says:

    hey….im not really sure whether its a stitch but i seem to have some sort of cramp in the side of my chest that wont go away.Its been there for almost to days and it happened while playing to much football.Im actually pretty fit and have run marathons before.Any idea on what it is?and should i go to a doctor?

    • Dean Hebert says:

      Any pain that lingers might be a sign to see a doctor. Even in the most fit there can be heart disease and atypical symptoms of heart issues. Of course it could be just a cramp or strained muscle in your rib cage. No idea really – many possibilities. Err on the conservative side… it won’t hurt to get it checked out and if nothing else give you peace of mind.

  37. Char says:

    Can someone tell me if it is better to hold your hands behind your head or bend at the waist making sure your head is up – after your run. Daughter was told by coach to put hands behind head, but personal trainer said to do the opposite… coach chastised her and told her she was being disrespectful (which she was not). Which way opens the lungs/chest more??/ help?

    • Dean Hebert says:

      First, there is NO research whatsoever supporting either method. Both pose possible solutions based SOLELY on their own interpretations, experiences and thoughts. The idea behind both approaches MAY work because they are trying to effect a stretch in a cramping muscle.. in this case your diaphragm. My personal preference is hands on hips and walk tall; you can even do some side stretches leaning at the waist but I have runners push up with their hands on their hips for leverage – it helps force shoulders higher upon INHALATION then drop shoulders upon exhalation. This exaggerates inhalation and exhalation phases of breathing forcing the muscles to stretch more. But I do NOT have research to back up my approach. I use my knowledge of anatomy (nursing background) and training. I know it works for some but not all.

      The bottom-line is this:
      1. There is no secret single cure.
      2. What works for the athlete is what you do.
      3. When all else fails… obey your coach.

      I wish I had a better answer.

  38. Tanner says:

    Hello. I also have been dealing with a side stich. I think that in my case it may be from drinking too much water before or during my running. I try to drink lots of water, starting about 5 hours before I run, and then stop about an hour before I run. This usually keeps me from having a stich, but during longer and more intense intervals of running (like at my 2 hour long soccer practices) I need to drink water in order to stay hydrated. When I do drink during soccer practice, I invariably get the side stich. So the way I see it, I can either be dehydrated without a side stich or hydrated with a side stich, and when I get a side stich, I can’t run. What should I do?

    • Dean Hebert says:

      I think the issue is moderation and experimentation. I agree, you don’t want to be dehydrated… not an option. You are hydrating well before… stopping an hour before is also good. So, odds are you are just drinking too much during your breaks in practice. Think a out this, 2:30 marathoners won’t take in much more than probably 20 ounces (of course it varies) – it is so fast there is little time to sit there gulping down water @ 5:45/mile and faster. So think about that 2.5 hours of constant exercise… one water bottle. Of course you do NOT replenish what you will lose but you limit your losses. AFTER and BEFORE is the time to make sure your overall intake is there – NOT during.
      Don’t gulp it down. One mouthful is an ounce. Space it out more. Save your gulping for after practice.
      And, rethink this… because you “feel” hot doesn’t mean you need more fluids in you (later YES.. immediately NO).

      Now, if you are highly susceptible to heat related illnesses (dizziness, nausea, faintness, etc.) you will have a far more precarious line to walk. You may not be able to take less fluids in. But the bottomline is to experiment with volume and timing during workouts.

  39. Tanner says:

    Thank you very much. I appreciate your help.

  40. Corine says:

    Wow…wish your blog was around 14 or so yrs ago! 🙂

    I played soccer for yrs (starting halfback no less so all I did was run the field all game like mad) and suffered in agony all because the fools around me said I must be dehydrated.

    Side cramps, shin splints and lung burning made me loathe running. If not for the adrenaline from games and drive of competition, I’d have never survived.

    I decided about a week or so ago to try running again, mainly for narcissitic reasons 😛 but also for cardiac health since heart problems are in both sides of my family.

    While I do pilates regularly, I really expected my body to be screaming after the first few runs. I’m pleased to say that wasn’t the case, and thus far the shin splint pain is minimal (usually it would rage within the first 5-10 mins of running and only get worse from there).

    While it went better than expected, I’m still frustrated by the burning in my lungs and those flippin side cramps. Based on what I was told yrs ago and the fact that I have some kidney issues, I was drinking like a camel after a long trek before my runs, cramping in the first 5-10 mins, and having no luck overcoming that throughout the run.

    After reading your article I think I’ll be poised for greater success in subsequent runs. The drinking less and far before runs alone I think should have a noticeable difference. (I’m only doing about 1.5 miles right now and stay well hydrated daily anyway.)

    Also, I breathe correctly during Pilates but when starting runnning again I’m breathing the way I always did then and pulling my stomach in on inhale. I learned belly breathing for singing…just going to have to translate that to running.

    The breathing will be my hardest issue (assuming shin splints don’t flare up again). I have to learn to breath in through my nose and out my mouth to try to reduce my lung burning (caused by athsma and multiple bouts of pneumonia/bronichitis w/pleurisy that ravaged my lungs). I can walk, chew gum, pat my head and rub my belly simultaneously, but for some reason breathing properly while running just eludes me 😛 (I will be checking out the device you mentioned above.)

    I never did manage to get over my side cramps in high school (nor did I with the shin splints) but hopefully with this new info I’ll be golden in no time! 🙂

    On a side note, regarding the question from Char 2 up about hands behind head breathing, when I was in high school my mom had graduated nursing school (late in life nurse…see you’re a nurse too…kuds BTW 🙂 and she started her career @ Shock Trauma B-more. I was having athsma issues and trouble getting deep breaths after a long run and one of the anethesiologists there told her to have me raise my arms up and either put my hands behind or on top of my head. (I usually go w/on top because I can lock my fingers and let my arms hang and stretch.) Anyway, the rationale was that with the arms raised, you’re stretching and extending your lats which then pulls up the ribcage some and gives it a greater area to expand to, thus allowing for greater expansion of the lungs and diaphragm/deeper breath, and more oxygen profusion.

    While that works for me, I played soccer with many who preferred hands on hips and that worked for them though. Think you have to go with what works/feels best for you.

    I’ll check the site but I’m also curious if you have tips on shin splints and lung burning as mentioned above, as well as you take on the Vibram and Merrell toe shoes. I’m part native american and have the traditional flat/wider foot so with that and shin splints I’m not sure if they’re advisable. Just curious on your thoughts about them.

    Great site. I’ll post on my progress using your advice! 🙂

    • Dean Hebert says:

      Thanks for your note and hope you continue to progress.

      The burning lungs is typical in dryer climates (I’m AZ) and for those who have asthma issues. It may never completely go away however it will greatly improve with conditioning. 1.5 miles is still modest running and my guess is until you’re comfortably running 4-5 miles it my be an issue also.

      As for shin splints you obviously need lower leg exercises. If you have never remediated the problem then every time you return to running you will have it crop up again. If you have lower leg issues you most certainly do not want to be wearing minimal shoes like Vibrams.

      Keep it rolling!

  41. Ryan Hofsess says:

    Hey, I am a varsity highschool cross country runner and also a senior. It is mid-season and last week I ran a big pr of 16:21in the 5k. Yesterday was our county invitational and I was expecting to medal. I ran a great first mile, coming through in 5:08 on a really hilly course. However, about a quarter of a mile later I got a terrible side splitting pain a few inches below my ribs between my 2nd and 3rd abs. I ended up running a terrible race (17:41) because as I went faster or maintained speed the pain worsened. I had this problem my junior year, during the mid-season, but it went away after a week or two. The pain came about almost every run- fast or slow. It also hurt even when just walking around, but not as bad as when running fast. I would like to get rid of this pain before my next big race. Please help.

    • Dean Hebert says:

      First, really look hard at that day. I don’t know what you were doing in your Jr. year but right now… analyze everything… what did you eat? How did you taper your training going into the race? Have you been doing hill training at similar intensities? Similar quantity? Were you stressed?

      Most common cause – as you read up top – is conditioning, something on your stomach or terrain.

      If you are truly at a loss, you can try doing what some other runners have done, take 2 ibuprofen an hour before the race or so but ONLY if you can tolerate it on your stomach. It does not work for everyone, but it’s one more possible solution.

      Use a technique for getting rid of or limiting them once they hit such as pursed lips breathing, tensing abs as you exhale…

      Good luck… drop a line on how it all goes.

  42. Trish says:

    Hi! I am training for a half marathon next month. My side stitches really seem to have no rhyme or reason. A week ago today I ran 8 miles without any cramps, without being out of breath and with plenty of energy left over to run longer (only stopped b/c of time). I was so excited this weekend to try for 10 miles, but I only got to 4 and that was with walk breaks. Part of that I think was I went while it was too hot (91 in Texas heat), but I also had the dreaded side stitch which I hadn’t had all week. I may have had water a little too close to my run too. I plan to try again this week for another long one. Will starting out a lot slower than normal help? It seems like there are times when the odds are stacked against me and I don’t get a cramp, and other days where I feel prepared both mentally and physically for a long run and can only get 3 or 4 miles in. Help!

    • Dean Hebert says:

      If you read through all the comments there is a lot of possible things to try. To answer your questions… yes heat that you are not used to can cause this. The water too close to your run could be a cause. Yes, starting out slower may help because it allows your body to warm up more before picking it up and… breathing harder as you do. You may also try varying the pace in this warm up phase and back off before a cramp hits – don’t wait until it hits. So, run easy, bit faster, bit faster, back off, up to race goal pace, back off… relax… play with it a bit… then when you are comfortable get into your groove.

      • Trish says:

        Thank you! I haven’t really tried variation of speed during the run except of course to slow or stop when the cramp hits. I’ll try that this week!

  43. Trish says:

    I did it! 10 miles last night and averaged at my normal long run pace even with the different variations of speed. So happy!!! Thank you!

  44. Susan says:

    I have cramps in my upper right abdomen, and from reading on here it sounds like they are diaphragm cramps. That’s good to know because I was wondering if it was my gall bladder, but they only last a minute or two and are unrelated to food… they seem more related to harder runs earlier in the day.
    So from reading the other posts, I should see if my posture is getting worse at the end of a long run, and then maybe do some back stretches on an exercise ball? It’s right up under my ribcage on the right, so I’m not sure if I can push into it or not. I hope it doesn’t happen in my next half marathon, because they hurt and leave that area tender and tight for a few days afterwards.
    Any suggestions would be appreciated!

    • Dean Hebert says:

      It seems like you are doing what you need to do. The back stretches on an exercise ball is a good idea. The only other thing I know some other runners have found to help is to take some ibuprofen or the like before your run. Of course if it bothers your stomach or you have issues with it don’t try that.

  45. Tommy says:

    Hey, im 15 and I just started cross country yesterday. Our first practice was on August 1st. I was getting a really bad pain in my chest on the right side after i ran about a mile or two. i did to track and feild in recent years. But this is my first year of Cross Country. I really havn’t had any exercise since yesterday and i was wondering how could i get rid of the pain in my chest. Thanks!

    • Dean Hebert says:

      Thanks for dropping by. Most of the ways to get rid of it are listed along with the extra comments. It’s an important message to you though that year round conditioning is the only way to increase the odds of not getting stitches.
      just in case… I hope you have had your physical and all other things are ok.

      Try the breathing exercises and patterns. But, it won’t suddenly just go away. You’ll be prone to these for awhile and really need to work at this. Otherwise every time you give a hard effort and breathe hard you will increase the odds of incurring another cramp.
      Sorry I don’t have a magic pill cure for you.
      Good luck.

      • Tommy says:

        Hey thanks for the advice i did read the comments and i will breathing exercises tomorrow at practice. We ran about 6 miles to day and i can honestly say that it was the most i ever ran in my life haha. But yeah today the cramps in my chest came a lot later than first few practices. Thanks a lot Coach!

  46. Laura says:

    Hi Coach Dean,
    Do you ever tire of hearing similar questions with slight twists? 🙂 On that note here’s another one-
    I’m desperate, I’m thinking about trying a sports specialist MD or high end trainer to stop these side cramps but would love to avoid these if possible. I’ve done my online research and have tried the forceful exhale with R down stride, side pinching, varied water/food intake, abdominal strengthening, posture changes, and deep breathing. They are the traditional downhill side cramp with running. I’ve been a runner for years and never had them until one race (half marathon) when I pushed too hard on the uphill in the beginning and got them wicked bad for ~4-5 miles on the downhill section. Since that race (~ 3 years ago), I get them with nearly every downhill run I do. It is soo frustrating! I’m in better shape now that I was then, evidenced by faster times on the same trails. I just want to enjoy downhill running again and am willing to try almost anything! (I will definitely try the ibuprofen idea but would also like to fix the problem). I’m pacing my husband in the Leadville 100 in 1.5 weeks and don’t want to let him down b/c of a side stitch/cramp. Please help! Tell me there’s another trick that hasn’t been posted!
    Thanks for all your efforts in this area that is such a struggle for so many runners.
    Colorado Springs, CO

    • Dean Hebert says:

      I’ve heard a number of times about a particular race or workout that yielded a cramp and that recurs in similar circumstances frequently. I have not encountered one as persistent as yours!!!! I wish I had more tricks. Ibuprofen is definitely worth a shot. I’ll through one other totally atypical and nontraditional approach – hypnosis. A hypnotherapist could work with you to reduce anxiety (at a subconscious level could be creating tension which precipitates the cramping) as well as coping and relaxation while running downhills – focusing on a flow, rhythm or fluid movement.
      Though I’m a certified hypnotherapist I haven’t worked on something like this before. But there is a potential. Find a CHt in your area. It may only take a session or two; they may even record the session for you to replay daily until it takes “hold” in your subconscious. But it is not unusual that just one session will do it. I would give it a go.

  47. Jacob says:

    Hey Coach,
    I’m running high school cross country and I get side cramps fairly often in races but hardly ever in practices.

    Our races are always 5k. My second race of the season, my side cramps came around the mile. It wasn’t extremely hilly and I believe I was breathing fairly relaxed. I slowed my pace some and tried forcefully breathing, but the cramp stayed until the very end of the race, and a little while longer at a less intense level of pain.
    My first race of the season came with no cramps. My 5k time was about a minute faster than my second time though. There were no hills on the first course.

    With the cramps, I always try to breathe them out, but it almost never seems to work. Occasionally towards the end of the race I won’t be able to feel the cramp anymore, but that doesn’t happen too often. My coach told me to kick as hard as I could at the last 200 yards, a longer finish than I am used to. This seemed to fix a cramp a little bit but not entirely.

    One of the few workouts that produce the side cramps are our ‘repeat 800 yds’. We run our half mile as we try to reach our goal time (mine is around 3:10 minutes). We then get about 2-3 minutes between each half mile. I can usually run 4-5 before a cramp comes on.

    One possible problem I came up with was my form. I tend to not swing my arms as much as I should. Also, could it be possible that a slightly shorter stride could cause some cramps?

    Some advice I’ve been given was that my core muscles are not strong enough. This doesn’t seem as likely because when we do core exercises, I can complete the exercises without too many problems other than what is to be expected from core training (grunting and the such from the intensity). My teammate that I run with is built pretty much the same as me, tall and lean. Sometimes he cannot finish the core exercises but in a race, he never cramps up.

    I read about your tylenol advice, and I will try it in practice in the following week. If it’s allowed in cross country, I’ll try it in a race as well

    Last year I was plagued by a side cramp in every single race. This year I want that to change but I need some help to fix them.

    Thanks, Jacob

    • Dean Hebert says:

      Thanks for dropping by. Yes, Tylenol is acceptable under NFHS rules. I agree that weak core strength is not always indicative of cramp or no cramp. Notice that your cramp comes on late in those 800s? That is a conditioning issue… not so much legs or lungs per se. But, it is that your diaphragm and ancillary breathing muscles (intercostals) etc. are not in shape enough to “last” long working hard. Stride is not directly related to cramping. However, if you are over-striding it would be something to address as that makes you less efficient, therefore you work harder at any given pace… making everything fatigue earlier.
      At your age the number one issue is by far for most runners is the lack of year long conditioning. Once you become a year-round runner (including speed work not just jogging around) you will find that your incidence of cramping will reduce or be eliminated.
      Drop by and let me know how it all goes. I’d love to hear your progress and results.

      • Jacob says:

        Hey Coach, decided to drop by and make another report after a few weeks.
        Today, I broke 19 minutes on a fairly flat course, just two small hills.

        I took 800 mg of ibuprofen due to my calf muscle causing me some serious pain. The pain killer caused my calves to feel great, but i still ended up getting side cramps late in the run.
        The first hill came around the 2 and a half mile. It seemed fairly fine up the hill, but at the top, i got these intense side cramps again until the end of the race.
        Next week will be my last high school race as I am the number 8 runner on my team and only the top 7 get to run at state, and because I am a senior I won’t be running competitively next year. I really want to go out and break 18:30 next Saturday. I know it will be hard, but I am pretty confident I will be able to do it, even with these late side cramps.


  48. Dean Hebert says:

    Well done… that is good progress even if you’re still getting the cramps – you’re able to run through them. Keep experimenting and keep running – even after your season ends. You’ll be able to run road race 5Ks all over. So, running and racing for you does not have to stop.
    Good luck!

  49. Hi Coach,

    I’m a triathlete who regularly logged around 35-40 miles run per week during the race season this year aside from swimming and cycling. My last race was the IM 70.3 World Championships Las Vegas in September. After a 2 week break of just a few light jogs I trained for 3 weeks for a 3-day/4-stage bike race, around 300 miles/week and only 2 runs of just 6 miles each (mainly just to exercise my dog). Last week leading up to the race I didn’t run at all. After the race I rested for 3 days and attempted to run. I hadn’t even run 10 minutes and my legs were severely cramping! I stretched, walked, and hobbled for the next hour and a half.

    Yesterday I tried again and the same thing happened; run (jog, actually) 200 meters, then limp, stagger, stretch, walk,try to run again… cramps… I gave up after half an hour of this.

    This morning was the same story. I did more stretching than I usually do , had a nice warmup walk of 10 minutes, did some drills, and still ended up cramping again. This time it got so bad I had to sit down until the pain went away: quads, glutes, hamstrings, everything.

    It’s becoming frustrating because I know I’m in shape and yet I can’t even walk properly once the cramps hit.

    Do you think I should keep trying every day for a little longer each time or are my legs just screaming for a break already?

    Thank you!


    • Dean Hebert says:

      First this isn’t the first I’ve heard of this… I don’t know of any name for this “syndrome” but I know it happens and lingers for quite some time for some runners.
      I don’t know of a sure fire cure. I agree it is highly unlikely that it is a conditioning issue.
      However, most of the time when I’ve seen this, it occurs after extremely hard efforts in races in which the athlete is truly depleted. I can’t say for sure but your body may have really been overextended during your stage race. It wasn’t running… it was physically taxing. Your body is talking to you.
      I don’t believe stretching is the answer. I like that you tried doing warm ups and drills a bit longer. I recommend this over stretching.
      Next, If I am right and that your body is talking… gotta listen. I recommend a week off. Go kick back. Eat well. Do drills, go for walks, sleep, get massages.
      THEN, take the approach of long warm-ups with drills… jog and stop BEFORE any cramp even HINTS at striking. Then walk, do more drills and repeat.
      Over a few days… you may be able to go progressively longer but always stop before the cramp hits.
      Wish I had the perfect answer. Drop me a line how it goes.

  50. Charlene Shelly says:

    Hi Coach,

    I have been training for a half marathon for a few months now. I run 7-9 miles (65-85 minutes) 3 or 4 times per week on the treadmill or between villages in a rural area with hills, dips, etc. I can run 9 miles without walking, sometimes slowing down to about 5.5 mph. Once in a while, the day after I run, I feel pain under my right rib cage even while walking around at work. It will disappear within a few hours.

    Thank you!

    • Dean Hebert says:

      I’m not totally sure but my bet would be that this is a conditioning related issue. Vary your workouts more. Get shorter much faster and longer easier runs in while you prep for the marathon. Too much of the same running will not enhance your conditioning as well or as fast as varying it. It could also be the hills/dips that instigate the cramp feeling if you are not accustomed to it because you run on the treadmill.

  51. Raghava Raju says:

    Hi Coach,

    5 years back i had an motorbike accident and had ligament tear and meniscus tear of my right knee joint. Until then I was a good athelete where i used to jog for 45 mins. Now I usually do 15 minutes on elliptical cross trainer at home. Last weekend I wanted to test my ability and started a jog for 20 mins on streets which has both uphill and downhill. I remember halting a second to tie my shoe lace. I did not experience any pain then. After coming back home which is 40 mins walk back after 20 mins jog. I started experiencing severe pain under my right rib cage. Its been 5 days so far I’m still experiencing sharp pain when i take deep breath, laugh , or yawn. Is there any thing to worry or will it subside over a period of time.


    • Dean Hebert says:

      Welcome back to running!!!! I hate to say it but you probably induced the cramp running for the first time – stressing your diaphragm – then perhaps when you bent over may have induced the tightness and cramping. Good news is that this most certainly appears to be a “conditioning” issue. If you can take some ibuprofen or the like it may help. In time it should indeed subside. Next time out, easy does it. Too much too soon and your body is going to talk to you!!

  52. riflelawson says:

    This is a great topic and I can assure you that side stitches are a very real phenomenon and are not reserved only for those who are “out of shape” or otherwise lacking in conditioning. I’m a former elite runner and have been plagued by side stitches my entire career. The major triggers that I can pinpoint are prolonged oxygen debt (I have never had them in a race 1600m or shorter) and downhill running. Once I have had a particularly painful episode, over the course of the next few runs, anything can serve as a trigger. Light recovery runs could cause massive side stitches.

    It is sad to say, but I had access to sports medicine doctors and not once did they ever express concern over side stitches. I was even referred to a general surgeon who operated on me to look for adhesions, but the procedure did nothing for me. I do tend to agree that people who are lacking in conditioning are prone to getting stitches more often, but when they are exacerbated by downhill running, even elites can suffer from them.
    I am currently trying to move up to the levels of the elite Master division and have started to practice some of the breathing techiniques thought to help with stitches. It is not easy teaching yourself how to breathe differently after nearly 30 years of competitive racing, but I have nothing to lose by doing so….except maybe those awful stitches.

    • Dean Hebert says:

      Thanks for dropping by and adding your perspective. Good points. And yes, faulty breathing of course is a reason for stitches – yet there is still no single reason and nobody seems to have a single cure! By the way I have also used a breathing device to help. It actually exercises all breathing related muscles.

  53. alex demetriou says:

    These solutions sound like they’ll help because I seem to get stiches on grass mainly and sometimes I feel a nerv sort thing in my shoulder I play football sunday and saturday and go gym monday wednesday and friday but no actuall fitness or breathing things for the stich I haven’t tried yet I really hope this works.

  54. Pingback: Muscle Cramps, Dehydration and Running | The Running World According to Dean

  55. Allyson Gray says:

    I have been running for about 3 years and am currently training for my first marathon. It has been going great but I had to take a week off because of my sick children and even though I did complete my long run at the end of the week (10 miles) no problem, I have been plagued with side stitches on all three runs so far this week. I have never had an issue with these before and I’m starting to freak out thinking its going to really hinder my training. I have tried stretching and the breathing techniques and I plan on trying to take an advil before my next run to see if that helps. It seems like these side stitches linger throughout the day. Is that normal? Should I see my doctor about it? Also, will it hurt my body at all to push through them? Lastly, a runner friend told me that it could be something in my ribs or back putting pressure on my diaphragm and I should see a chiropractor…does that seem possible?

    • Dean Hebert says:

      If your long run is dramatically longer than past runs it is possible it is just the distance – a conditioning issue. If however it occurs early in your run – say mile 3 – but doesn’t occur in other runs around that mile mark then something else is going on. For instance, OVER hydrating before a long run so your stomach is more full on the long run to start with.

      If the ibuprofen doesn’t work, perhaps see your Dr. Odds are they won’t find anything though… just be warned. If it is a cramp/stitch of some kind – no- there is no harm in running through it. However, if it is caused by something else – I can’t say. Yes, there are times stitches can stay with you long after a run. Not common, but yes indeed it can happen. Also, after taking some time off without any running – like when you were caring for your kids – coming back can indeed induce cramping from suddenly starting up again. That should subside though soon with returned consistency.

      Highly unlikely that something in your ribs or back is causing this. Though I believe in chiropractors this is not their expertise – curing cramps. (Though in my experience…. of course they will tell you otherwise because they appear to find that they can cure almost anything with a back adjustment.)

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  57. Cheyanne says:

    Hi! I’m a high school runner and I have a side cramp right below or sometimes under my rib cage. My cramp has been lasting since Saturday and still hasn’t gone away. It doesn’t hurt at first but as I start to run it bothers me and goes away and comes back frequently. I have been pushing on it and it does help but it ends up coming back. Also when I raced yesterday it hurt on the warm up but for two of my races it didn’t hurt but as I ran my last race the cramp came back. I can also feel it when I drink water and it is not a pleasant feeling. I’m not sure if its a tight muscle or what not but I am icing at this very moment. In cross country season the same thing happened at it lasted for a week and a half but eventually went away. I wanted to know what you thought of my predicament. Thanks!

    • Dean Hebert says:

      I have heard of cramps coming and going and also lasting days. The fact that it recurrent (happened last fall too) yet long episodes in between without it could mean a conditioning thing. Did you run all winter between XC and track seasons? You need to if you didn’t. That is ONE step towards correcting this. If the cramps come on or are initiated by a hard race or workout then it is most likely poor breathing pattern (you’re not belly breathing) or it’s conditioning or a combination of the two. So to prepare for the coming XC season – you need to run all summer and make sure you do some hard efforts not just a bunch of jogging around. Then practice belly breathing… you can youtube it for some examples. Good luck!

      • Cheyanne says:

        I did run indoor track over the winter so I did do running. I will look into the belly breathing! Thank you!

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  59. Harold says:

    I am an athlete i run almost every day but lately i get chest pains just from joggin but g im in shape so it makes no sense. Can you please help me?

    • Dean Hebert says:

      Harold – there are too many possibilities and your description is far too vague to address. You should see a doctor and get a stress test done if this is something new for you.

  60. Lisa says:

    Any advice for a 9 yr old that is getting these in the middle of soccer games, sometimes just during jogging for warm-up? Getting REALLY frustrating for her, coaches don’t seem to be sure if she is faking, or at least that is her perception. This is a trim kid that does conditioning 3 times a week. We will check out youtube for belly breathing training….

    • Dean Hebert says:

      Now, if it is truly only during warm-ups (not competition and not during full practices) – my first response is “who cares”? I don’t mean this to be sarcastic. Think about it. This does not and is not adversely affecting actual athletic performance. Maybe your 9 yo is lucky and “getting out of his/her” system in warm ups and all is well.

      Now if these hit at other times then…
      For youth especially the two top reasons are improper breathing – so yes, check out belly breathing. And conditioning is the other. So, just enduring it while controlling breathing properly until higher levels of fitness are attained. Conditioning 3 times a week is quite modest and may need to be increased OR the intensity of workouts increased along with duration. It’s about conditioning.

  61. shawn says:

    I started running back in feb. One mile a day. I have slowly increased my distance and now run four miles a day, with one day off. My last two runs, I have had the worst side stitches ever! My body is used to running so I don’t understand why they start so suddenly. I run the same route daily at the same exact pace. Could the time of day have something to do with it? I notice on my morning runs, I had no issue. I am taking a couple days off, because the ache is dull, but constant at the moment.

    • Dean Hebert says:

      First go back to a few morning runs and see if it is gone. If so, then you need to isolate what you are doing or not doing that is causing it as it relates to activities prior to the run that are different.

      I would strongly recommend varying your pace, changing your route, and change distances with more days off. The variety will enhance your conditioning far faster and that is of course one point that contributes to reducing cramps.

      Other than that – look to diet and warm up routines for other possible guilty parties.

  62. Jan says:

    Thank you for your informative article! I am a beginning runner and have been struggling with side stitches. They happen almost every time I run. Most people’s cramps seem to occur well into their exercise, but mine start during about the first half mile. I have been told that I might be running too fast, but that doesn’t seem to be the case. Does this indicate something else? I have been trying to take deep breaths, but I might be forcing myself to breathe too slowly. Is there such thing as controlling your breaths too much?

    Also, when I get a cramp, is it better to stop running or just keep going? I have heard that starting and stopping all the time can cause cramps, but others say it is better to stop. Thank you!

    • Dean Hebert says:

      Patterns of cramping vary widely so don’t think yours is unusual. Many get cramps early on in their runs.

      “Too fast” is a relative thing BUT if you are breathing extra hard then it is a reflection of the #1 cause – conditioning or lack thereof. And since you state that you are a beginning runner, that is most likely the reason. It’s not specifically the PACE but that you need to continue to condition yourself and your breathing muscles.

      Yes there most certainly is an issue re: controlling your breathing too much. The “patterned breathing” techniques are somewhat absurd. There is no magic to pacing your breathing on some arbitrary pattern of in/out every 3 strides or whatever. You are running. Your body is craving oxygen to feed the muscles. Why would anyone arbitrarily restrict breathing to a pattern? You MUST supply your body with the amount of oxygen that your body needs. Period. The faster you go the more oxygen you need. Period. Breathe freely as your body needs it – breathe in and out of your NOSE AND MOUTH. Any restrictions will cause unnatural breathing patterns and actually increase chances of cramping. But, be sure you are doing belly-breathing (just check youtube for a demo).

      No secret on stopping or not. It’s individual. Try both. See what works. Sometimes you can run through it and it goes away… sometimes not. Sometimes just slowing down does it. Because it works for one person doesn’t mean it’ll work for another.
      Hope this helps.

  63. Victor says:

    I’ve been having issues with side cramps for a while now. I’m in high school running cross country and I run on my own on the weekends. However when we have our meets where we run our 5k’s I’m fine for the first 2 miles into it but then around maybe 800m into the third mile I tend to cramp heavily one the right side underneath my rib cage. The terrain is flat and pretty level so I don’t think thats the issue. Its painful and makes my breathing very labored. I eat well the night before and push my fluids that day as well. Do you have any idea why I would be crapping. I’m planning on using some of your solutions to help me.

    • Dean Hebert says:

      Your symptoms most likely are ones due to lack of conditioning. Late in a race, you are fatigued and working harder to maintain pace or even pick up the pace – that places a larger demand on your aerobic system. That means you have to breathe deeper, faster to get more oxygen to meet the demands of the muscles. You may be in decent running shape with the running you are doing (BTW congrats on running on weekends) but you are probably not running hard enough workouts to condition you for that late in the race work load. Your quality training volume (that means race pace and faster runs) needs to increase. You should be logging MORE than 3 miles in a quality session. (i.e. 14-16×400 repeats @ your goal 5K pace or just faster, and only 45-60 seconds recovery between). Workouts like that will condition you for that late effort in a race. If you don’t mimic that late in the race fatigue, you won’t be able to condition yourself to overcome cramping.

      In the mean time, practice deep, belly breathing (see examples on youtube if you have to); do NOT try to hold your breath or slow it down or artificially do something with your breathing. You breathe hard because your body needs oxygen. Breathe through your mouth NOT just your nose. Run tall and not bent forward (which often happens when we fatigue). If you feel a cramp coming on, you can purse your lips and breathe out hard on each exhalation (tighten abdominals as you do so). Purposely engaging your abs has helped many people.
      Good luck.
      Drop a line here on your progress.

  64. Victor says:

    This 5k I didn’t cramp up towards the end of the race and I did what you advised pursing my lips and breathing breathing hard and it did help. I also am working to change my teams training agenda to what you advised because its not only me having trouble with the cramps and side stitches. Also I have another question for you. I grew up in a colder climate that what I am now living in North Carolina do you think my cramps may have to do with my body not being fully conditioned to the humidity and heat which I’m not used to?

  65. Junior says:

    Hey coach,
    I am 22 year old guy that just got back into doing MMA(mix martial arts) I was sick with a cold for about a week and now I returned to practice after laying off the sport for about a year anyways yesteday during sparring i got a really bad cramp on my right side under my rib th at was killing me every time I breathed. Now its the next day and I still feel.the cramp whenever I breathe in. I am wondering why I still have this cramp ?

    • Dean Hebert says:

      Very bad cramps can indeed be felt days later. It’s not unusual.
      If during your week off you didn’t do any exercising it is quite possible it is a reaction to the lack of activity then suddenly subjecting yourself to a rigorous workout. Often after an upper respiratory infection there can be some respiratory issues. Combined… the tension in abdominal muscles you would have in MMA plus labored breathing… may have caused the cramping.
      Stretch out your abs and chest. Warm up very well before getting into anything rigorous. It may take a few days to completely get rid of it. You may even need more modest workouts for a few days. But providing you didn’t do anything like strain a muscle or the like you should be ok with a bit of patience.

  66. Junior says:

    Ok yea im still congested but that makes sense thanks for the response.

  67. Deepak yadav says:

    Hi coach i m practicing 4 military pft in which we have 2 run 1 mile in 5.15 minutes so suggest me something benificial nd in detail about belly breathing thanks a lot sir

    • Dean Hebert says:

      You will mostly benefit from just getting in shape. That will decrease any side cramps or stitches you may be getting. Don’t focus on too much on breathing “technique” that is seldom the issue. Review what is said about prevention in the article – not much I can add on belly breathing. You can go to youtube perhaps and find an actual demonstration. But your #1 focus has to be on conditioning.

  68. MelB says:

    I’m a beginner runner (jogger!) and am now managing around 25 mins straight. I have experienced side stitches before, so I’m pretty familiar with the pain of those, but what I’ve been getting is more of a burning feeling right under the xyphoid process on my sternum when I run. The pain isn’t enough to make me stop, but it’s constant for at least the first 10-15 minutes and is quite uncomfortable. I assume it’s still related to the diaphragm, but it’s a definite burn, not pain. Any suggestions as what this might be? Thanks

    • Dean Hebert says:

      That would be unusual for a cramp but perhaps not impossible. You might just have some acidy stomach – that burning???? Breathing hard could make your stomach churn a bit. If so, try some tums or antacid before you run. Worth the experiment. Wish I could be more help.

  69. cherise says:

    Hi Mel
    I am the mother of a young runner. My daughter is 11 years old and runs 5k road races. She can run a 5:50 mile, yet has cramping issues in a number of races. The cramps sometimes start before the race even begins or at the start line her stomach feels very tight, leading to cramps at one mile. Could this be due to anxiety, leading to shallow breathing, which then causes the cramp. or is it more likely due to minimal mileage(10 -15 total miles a week) We’ve tried no food before the race and recently we tried a banana 1:15 before the race. I thought about telling her to go out much slower than normal in hopes to ease anxiety.

    • Dean Hebert says:

      You’re doing the right things. First I think it’s conditioning AND pacing – her miles should be for the most part evenly paced… that means mile 1 and mile2 and mile 3 are close to the same times. Going out hard will most definitely increase chances for cramping. At her age I wouldn’t increase miles much. She could handle a few more but it isn’t that important on this issue. Some of her training miles however have to be of quality. She needs to get used to running at race pace and faster in SOME training sessions.
      Food of course is a possible cause. Good direction.
      Finally yes, since some symptoms begin prior to races it indeed could be anxiety or stress induced that leads to the cramps. But a little bit of tightness or butterflies in her stomach is NOT necessarily bad. That is what is needed – in moderation and in full control – for optimal performances.
      If you need help for either running training schedules or mental game coaching drop me a line.

  70. Kirk says:

    I’ve had asthma all my life. When I try to run I get stitches in my side rather quickly, If I try to “tough it out” I eventually get a small air bubble in the back of my throat that is difficult to breathe past. I’m pretty sure a lot of this has to do with my breathing, when I run I can’t get enough air to my lungs by breathing through my nose so I end up breathing through my mouth is there any way to successfully run breathing through your mouth and not getting stitches or that “bubble”?

    • Dean Hebert says:

      Yes indeed you SHOULD be breathing out of your mouth and not your nose. Otherwise you restrict oxygen!!!! That of course increases labored breathing which will ultimately CAUSE more stitches.. not relieve them. The idea is to get used to deeper “belly” breathing and not shallow breathing. My #1 advice I give right now is to get one of the Power Breathe inhalers. And then use it as part of your warm ups (3-5 minutes of breathing with it). And use it everyday until you develop your entire breathing support musculature… which will decrease your effort of breathing and decrease instances of stitches.

      • Kirk says:

        I was actually referring to Inhalation not exhalation, I have abnormally large lungs (2 x-rays are needed to get a full picture of one lung)

  71. billy says:

    ok its pretty simple for me. im 18 years old and have recently decided to get in shape. im very skinny only 57 kg. i started running about 2 weeks ago and was going well. then the other day i started running and got stitch almost strait away (like 10 seconds after starting running) it got worse until after about 1 minutes i couldn’t even continue to run. its weird because only yesterday i could run 3 laps of my local oval at what i would consider to be a above average pace with out anything and yet today i cant even run to the end of the street? is this normal for someone who is starting out?

    i read in the main article that new runners often get stitches but i think this is different because i havent been getting them untill now.

    just wanted to put this out here and see what people have to say.

    • Dean Hebert says:

      Yes indeed this fits the pattern. The nature of stitches is that when you aren’t i. Condition they hit and can be either predictable or unpredictable as to when. As you gain conditioning they should lessen in frequency and severity but be patient… This could take a long time to be rid of them. Be persisten and consistent in your training.

  72. Philip says:

    Glad I found this post, just reminds me that 15 years is hard to regain quickly, pain is just a side effect of getting out of shape and trying something harder than my body agrees with yet. Will look forward to getting back in shape to get rid of hill cramping. Thanks

  73. daniel says:

    I just ran yesterday, about 4 miles and about a mile I started getting really bad cramps so I slowed down to accommodate and then eventually started again and on my last mile around my neighborhood I had some intense stomach pain and had to walk the rest of the way. I’m currently 14 years old and its been a 2 days about after the cramp and whenever I move it seems the cramp comes back. Do you know how to end this cramp? I couldn’t play in gym today because of how severe it was, Ive tried everything including deep breathing stretching. I’m a regular athlete but since the change of season I have started running again probably 3 other times before this, and the injury is in the left upper part of my stomach, would you know how to fix this or treat it to get better because I love running and would love to get back at it.

    • Dean Hebert says:

      That’s one of those very bad cramps that sometimes lasts for awhile. I assume you have no other health issues going on. But if it is a stitch it is most likely due to lack of conditioning or improper breathing… especially at your age. The good news is that if you get consistent with your training and develop proper breathing techniques it should go away. There are many recommendations already listed in these comments. Try them out as your first defense in getting over this. Slow down so you don’t breathe so hard. Don’t try to do too much in any one workout. It’ll just start all over again if you push too far or too hard. And get consistent with your training.

  74. Janet says:

    Hello. I am 36 and last year (April) I started exercising regularly to get back in shape. I started running 20 min 3x per week using High Intensity Interval Training. Originally I started out in the 5-6 MPH range and am now up to 25 min at 6-7 MPH. I had a lull from December to February of this year. Ever since I started running again in February I have consistently been getting a side stitch on my right side at about the 15 minute mark (it happens more often than not). Usually I can work through it since I am typically 5-10 minutes from completion. I am often able to make it go away by concentrating on my breathing, but I am more concerned over the fact it happens so often when last year I had no issues. I ensure I don’t eat for at least 2.5 hrs before running and don’t drink water for an hour (a change I made to help with the cramps), but neither seem to help.

    • Dean Hebert says:

      I think it’s a conditioning thing – Dec-Feb was in physiological terms is a very long lay off. The faster pace is probably the most likely cause. As long as nothing else has changed – diet, medications, breathing patterns or Ab work… try backing off a bit to your old pace for a bit. I’ll bet you’ll get there.

  75. Sarah Moore says:

    Thank you so much for this post! Albeit I read it after my race on the weekend, it’s still helpful for future ones. I just ran my first half marathon on the weekend, and was plagued by the side stitch in the last mile! It happened during an uphill climb. I believe it was definitely (as you pointed out) because I was pushing a little bit more at the end of the race than I would in a training run. And, because I’m a returning runner after a knee injury (I suffered a patella fracture, two and a half months ago; no surgery). It serves me right; I should have kept my cool and slowed it down. Anyway, it happened: lesson learned. I overcame it by stopping to catch my breath, then using a yogic (ujjayi) breath, which is belly breathing (as you pointed out), breathing through the nose only. This was a challenge also because the stitch hit just as I reached the top of the hill, so I had to overcome it on the downhill. The ujjayi breath worked wonders and I was over it in about 30 seconds. I kept the nose breathing until the finish line and finished with a sprint.

  76. Sage says:

    I am a 13 yr. old x-country runner and recently I have started getting cramps almost immediately when I start running. This started yesterday when we did a long run. When I did the warm up lap I got a bit of a cramp and then we stretched and stuff and then began the run and I quickly got a cramp. It got worse and worse until I had to stop and couldnt stand up straight. After that I took it easy and ran with another girl who was having similar problems. Throughout the entire run I was having to stop and walk about every 5 mins. which is highly unusual for me. I rarely get cramps but when I do they are normally at the end of a workout and I can push through them and they g away, but these get worse and worse and come back just a few mins after I recover. Today we did more of a cross training work out but i would get cramps when we would run like 200 meters. I have never gotten a cramp on a da where we do this workout which we have done several times in the past and I have been doing cross country for 3 years. WHAT IS HAPPENING TO ME?!?!

    • Dean Hebert says:

      First… you’re not alone I’ve heard of things like this before. The good thing is that eventually it goes away. But, sometimes there can be lingering occurrences.

      A couple things… if your “side cramps” are bothering you anytime OTHER than working out it may be something other than a true side cramp. Get it checked out.
      Sometimes if you have a severe side cramp they can indeed stick around for awhile. Stretch & strengthen exercises to loosen up. Stretch your abs and waist muscles.
      Check to be sure you aren’t tightening up and changing your breathing patterns. Learn to relax and use full belly-breathing if you feel it coming on instead of tensing up.
      Use some of the other ideas in the original post.
      RELAX! the more tense or worried or preoccupied you get with this – you will only make it worse.
      No single secret to ridding yourself of this. Keep working through it.

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