The Hidden Cause of a Side Stitch When Running
Key insights: 60-second read
- A side stitch isn't caused by running itself - running is a normal human movement. It's the repetitive, sustained nature of running that exposes hidden dysfunction you've taken into the run.
- The hidden cause is often lower back dysfunction - stiffness at the base of the rib cage and top of the lower back can cause the tissue at the front to tighten or spasm by way of compensation.
- A simple foam roller or ball release can help - by finding and releasing the restricted segments in your mid-to-low back, you may see a complete resolution of your stitch relatively quickly.
- Posture and daily habits are the root cause - the positions you unknowingly put your back into most often (sitting, standing, bending) create the dysfunction that shows up when you run.
- Test on your next run - release your back before a run and see if the stitch changes. If it does, you've found the missing piece of the puzzle.
Have you ever been in the middle of a run, feeling strong, and then - bam - a sudden, sharper pain in your abdomen or side forces you to slow down or even stop? That could be a classic side stitch.
If you're a runner, you'll know how frustrating and annoying they can be. But have you ever taken the time to think about why they happen? More specifically, why is it one side and not the other?
Typical explanations like breathing, fitness, or diet make sense on some level - but they aren't specific enough to explain why one exact part of your trunk becomes dysfunctional when doing something normal like running. In this guide, I want to share what I've come to understand is the hidden cause of a side stitch, a simple exercise to address it, and what you may need to change in your day-to-day life to keep it from coming back.
On this page
Context: Why Running Isn't the Cause
One of the big misconceptions with a side stitch is that we tend to blame running. In a way, it makes sense - the only time you get a stitch is when you run. So it feels logical to point the finger at running.
But if we take a big enough step back, we know that running is normal. It's a normal expression of human movement, and one of the things we're designed for. And one of the big themes I'm always trying to promote is that we shouldn't expect normal things to cause abnormal things.
"While running shouldn't be the cause of your stitch, it can certainly be the thing that's really good at exposing any hidden underlying dysfunction that you've taken into running."
Running has lots of repetition and an element of time involved. These will test the robustness of your mechanics. If you're running faster, if you start to fatigue, if you're running up and down hills, if you're sprinting or changing directions - as the demands increase, so does the ability to expose that hidden dysfunction.
The Hidden Cause: Lower Back Dysfunction
As a physiotherapist actively trying to understand the root cause of dysfunction, the biggest hidden cause of a stitch I find clinically is back dysfunction.
If you unknowingly acquire some dysfunction in your mid-to-low back - around the base of the rib cage and the top of your lower back - that area seems to have a consistent influence over so many common aches, pains, and dysfunctions around your trunk, hips, and below.
Mechanically, what seems to happen with a stitch is this: when you develop dysfunction at the base of your rib cage or the top of your lower back, the muscle tissue in that same area - when coupled with the demands of breathing and movement during a run - can cause some of the tissue around the front to tighten or even spasm by way of compensation and support.
Key Concept: What I've consistently found is that by locating and resolving the stiffness, tightness, and overloaded tissue in that part of the lower back, we see a complete resolution of the stitch relatively quickly.
The Foam Roller Exercise
As always, I don't want you to have to trust me - we need to base everything on results. So grab a foam roller, tennis ball, or lacrosse ball and give this a go. Then test it on your next run.
How to Release Your Lower Back
- Setup: Place the roller (or ball) at the base of your rib cage, in your mid-to-low back. You can lie on the floor with your hands behind your head, or put your head and shoulders on the ground and drop your hips down for more tension.
- Find the spot: Don't roll up and down your spine. Instead, find a specific segment that feels stiffer, tighter, and more restricted than the others. Roll slightly from side to side to locate the most restricted side.
- Hold: Stay on that restricted area and gently let the roller press in. Let the soft tissue and joints release. Spend 30 seconds to a minute here.
- Work through the area: Move up or down a fraction and find the next restricted spot. Systematically work through the base of your rib cage and top of your lower back.
- Test: Go for a run and see how you feel. If you normally get a stitch and you don't - or it's less severe - you've found a key piece of the puzzle.
"Using a roller on your spine - especially your lower back - is inherently safe. Your spine is not fragile. Putting pressure through your spine or the joints of your spine is normal."
If you have any cause for concern - perhaps you're osteoporotic, you have lower bone density, or any other reason to take caution - please be sensible. But for most people with a stitch, finding which part of your back has restricted tissue that might be causing dysfunction through the front is a very valid exercise.
Why Did Your Back Become Dysfunctional?
If your spine is involved, the next discussion point is why that exact part of your spine became dysfunctional in the first place. If you solve the mystery of why you get a stitch but don't also figure out why that part of your back is dysfunctional, then logically, the stitch may keep coming back over time.
Clinically, this is often a result of positions and shapes you unknowingly get into the most throughout the day.
Common Positions That Contribute
- Sitting at work - especially if you're slouching or twisted.
- Sitting in the car - long drives in the same position.
- Sitting on the couch - sinking into the same spot.
- Standing and bending - for those who work in kitchens, checkouts, or lean over a lot.
- Any position where you're kicking a hinge into that part of your spine, potentially with a twist, for long enough and often enough that the tissue becomes stiff and tight to cope.
Key Concept: If we want to truly resolve something, we need a helpful exercise. But we also have to pair it with something that gets to the root underlying cause of that initial dysfunction - so you don't have to care about this stuff anymore, and you can just do normal things like running and breathing.
Side stitches when running are frustrating - but they aren't caused by running itself. They're caused by hidden dysfunction in your lower back that running exposes.
The steps to solve them are:
- Release the restricted segments in your mid-to-low back using a foam roller or ball.
- Test on your next run to see if the stitch changes.
- Address the daily positions and postures that created the dysfunction in the first place.
If you do all three, you give yourself the best chance of leaving side stitches behind for good.
- Grant
Frequently Asked Questions
Why do I only get a stitch on one side?
If your back dysfunction is asymmetrical - which it often is - then the compensation and referred tension will tend to show up on one side more than the other. The twist or hinge you create in your daily postures may bias one side, leading to a stitch on that side when you run.
Can I use a tennis ball instead of a foam roller?
Yes. A tennis ball or lacrosse ball works well, especially if you want more specific pressure on a particular segment. You can do it lying down or standing up against a wall. Choose the version you feel most comfortable doing.
How often should I do the release?
You can do it daily, or before runs if that's when your stitch tends to occur. If you find it helps, you can also incorporate it into your routine to keep the area free. But remember - you also need to address the daily postures that are creating the dysfunction.
What if releasing my back doesn't change my stitch?
If you don't notice any change, either you may not have been in the right spot, or this isn't the cause of your stitch. In that case, it's worth consulting a physiotherapist to explore other potential contributors like breathing mechanics, hip function, or training load.
One key insight from this video
"Running shouldn't be the cause of your stitch - it's the thing that's really good at exposing the hidden underlying dysfunction you've taken into running. The biggest hidden cause I find clinically is back dysfunction at the base of the rib cage and top of the lower back."
Need personalised guidance for your running pain?
If you would like help making sense of your side stitch, running pain, or general musculoskeletal dysfunction, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
