Runner’s Stitch

By Kenneth Goodin DPT CSCS

What is a Runner’s Stitch?

Exercise related transient abdominal pain, more commonly known as runner’s stitch, has many theorized sources. Ischemia, stress on the membranes supporting the internal organs, abdominal cramping, compression of the celiac artery, irritation of the parietal peritoneum, or aggravation of spinal nerves. It is thought that irritation of the parietal peritoneum, is the most likely answer. Typically pain is reported as being along the lateral aspects of the trunk or abdominal region.

Woman runner in yellow holding her abdomen due to a Runner's Stitch. JOI Rehab

Woman with a Runner’s Stitch

What Causes a Runner’s Stitch?

There are several potential causes that lead to getting a runner’s stitch, albeit most are anecdotal as it is difficult to reproduce in a lab setting. The most common are:

  • Consuming food too close to the running activity, within 2 hours. Hypertonic fluids are found to be more likely to lead to getting a stitch as compared to isotonic and hypotonic fluids.
  • It is found that those under the age of 20 are nearly twice as susceptible to the condition as those over the age of 40.
  • Poor postural control was also found to be related to higher incidence.
  • Decreased conditioning level was found to increase likelihood of getting a stitch.
  • While other exercise activity can lead to greater likelihood of a stitch, running is around 3.5 times more likely to cause a stitch.
  • Poor warm-up strategies and cold temperatures have anecdotally increased the likelihood of getting a stitch.

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What are the Symptoms for a Runner’s Stitch?

Pain in a specific, typically abdominal, location with sensation being highly related to severity. High level of pain relating to sharp stabbing reports and low level of pain relating to dull aching cramping reports. Pain is typically reported across the mid-section of the abdomen, with greater reports on the right-side vs the left. In a small subset of reported cases, shoulder tip pain was also reported. Thought to be related to phrenic nerve irritation.

Man in blue shirt holding a runner's stitch with information about abdomen pain. JOI Rehab

Pain from a Runner’s Stitch

How do you get rid of Runner’s Stitch?

  1. Plan ingestion of food to be no less than 2 hours prior to running, along with regular consumption of water and avoiding hypertonic fluids. Hypertonic fluids would be drinks that are high in carbohydrates, such as sodas or energy drinks.
  2. Improvement of postural control in order to improve core function.
  3. Applying pressure on the site in conjunction with deep-slow breathing has been shown to improve symptoms.
  4. Wear of a stability belt; although improving functional core stability is the long-term goal.
  5. Steady improvement of overall conditioning, as those with higher levels of conditioning/training tend to report less cases of stitch’s.

Written By: Kenneth Goodin DPT CSCS

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