Written by Erik Bonn

As a former collegiate runner and now health care professional I have experienced or seen almost every running injury possible. Here is the first of four most common running injuries explained with simple solutions to get you back on track!

What: Side Pain

Pain in the side of the stomach or sometimes termed a “side stitch” usually happens on the right side just below the ribs.

Why it Happens:

1.) Running on a full stomach whether that is too much food or liquid can cause the digestive system to begin working and it will start to pull blood into the stomach. Additionally, if you are running, your body wants to pull blood away from the stomach and into the extremities. As one can see, this causes a tug a war with digesting and exercising, because the stomach wants to break down the food/liquid while your extremities are trying to run. 

2.) If food/drink is not the problem then it is most likely your breathing. Improper breathing is a large issue I see with most of my patients. The human body has a primary and secondary breathing pattern. The primary breathing pattern is utilizing the diaphragm appropriately by filling the belly up with air. Unfortunately, most people will utilize this pattern as their primary breathing and in turn causes problems such as side pain during exercise.

3.) The liver sits just under the diaphragm and has 3 ligaments that attach to it. If one is not using the diaphragm appropriately it can cause the liver to shift around and make the deep core musculature go into spasm. This type of spasm is what people are experiencing as the runners side stitch. 

How to Prevent:

I recommend you don’t consume large quantities of food or drink 2 hours prior to running. Instead, sip casually before hand and make sure you’re properly hydrated before you go on your run.

No matter what sport my patients play, each one of my patients always begins with breathing mechanics. The diaphragm runs 360 degrees around your lower ribs/belly area, so not only does the belly button have to come forward but also the sides of your ribs should elevate as well. As one exhales, the belly button comes closer to your spine and the lower ribs will depress. The secondary breathing pattern is with the upper chest/lungs area. 

Once the breathing pattern is established, a breathing cadence can be incorporated to eliminate side stitches. A breathing cadence is something along the lines of inhaling on two foot strikes then exhaling on the following two strikes. This may need to be adjusted for each individual but it will be a great starting place. 

If you’d like more information on proper running mechanics or information on how to deal with an injury you’ve experienced, please reach out to info@fusion-pt.com.


All the Best,

Erik Bonn MS, LAT, ATC, PES

Fusion Physical Therapy & Sports Performance