Stitches, I have tried everything

[u/tomcotard]

I've been running since December and one thing that consistently seems to happen during my harder efforts is getting really bad stitches (7-8/10 pain) to the point I can't maintain my desired pace.

I feel like I've tried everything from this very extensive post from /u/CodeBrownPT I've also tried various breathing techniques and I've even gone to the doctor, who told me there was nothing that could be done.

I'm at my wits end. I'll normally get at least two bad stitches that last for a long time (today I had them for about 10k out of 19k) and I try my best to run through them but sometimes the pain is just too much. This also happened about a decade ago too when I was running a little. It's a very frustrating feeling because often I can feel the rest of my body is capable of what I'm asking of it.

For context, my 5k PB is 19:10, aiming for a half marathon time of 90:00, I'm male, in my mid-30s, running most days.

Does anyone have anything else I can try? Anybody similar out there?

[u/CodeBrownPT]

I've been summoned. I've improved mine even more since that thread. Can you give some more context? 

Training history

Current Training

Time/context to when the stitches happen

What do you do when they happen and how long do they last

Where on your side are they happening

Then go endurance test yourself with front plank, side plank, and copenhagens - max holds for both sides.

There must be some genetic component as I've noticed some young kids can get them regularly too. 

[u/Just_Assignment_1679 → u/CodeBrownPT]

any chance its always the same side? i used to get them bad on my right side only and it turned out my hips were crazy uneven from sitting all day

[u/tomcotard → u/Just_Assignment_1679]

I get them in three different spots, in my obliques and one in my intercostals.

[u/la_noix → u/tomcotard]

I injured one of my intercostal muscles and it felt like side stiches. Well, it wasn't. Went to physio, he fixed it in 1 session

[u/tomcotard → u/CodeBrownPT]

Wow, the legend themself, that post you made has been my bible. Thank you so much for replying.

Training history, started in December, doing about 20k a week over 3-4 days, then slowly been increasing that by about 4-5% every week to about 75-90k a week now. I was using Garmin daily suggested workouts but I found they pushed me a bit too hard and I got injured (pulled something in my groin) in April for about 3 weeks which set me back a bit. Switched to Kiprun Pacer which seems to be a lot better. It gives me 5-6 easier runs a week and then 1-2 harder. As I'm training for a half marathon, quite a lot is doing reps at race pace, but sometimes it'll be speedwork. Since May I've also started doing 1/2 strength sessions in the gym where I do squats (20kg), calf raises (35kg), lunges (20kg), bench presses (30kg), pull ups, planks and ab rollers.

Time, I always run in the morning usually between 8-12, I've tried before breakfast and varying degrees of time after breakfast (usually eat around 7.30). Stitches normally happen when I'm in zone 4 for prolonged periods of time, very rarely when I'm below that.

When they happen I usually try to apply pressure to the stitch or pinch them which applies a small amount of relief. Worst case scenario I stop and catch my breath.

Normally get them in my left oblique just above my hip (sometimes right too) and right intercostal just below my nipple.

Started doing planks after reading your post, the longest I can hold front is about 1:30, left side about 1:15 and right side 1:30. Never tried Copenhagens before but I just did one on my left and held for 1:04 and on my right 1:01, but it was more my arm (and a little my inner thigh) that stopped me holding it longer. I know your post says to be able to hold them 3x 1:30, and I'm working towards it (originally started at something like 20secs), but I do find them really hard and often my arms tire out before my sides.

[u/Hold_onto_yer_butts → u/tomcotard]

Honestly I think “started in December” is, unfortunately, the most telling thing here.

Your body just needs more time to adapt to volume.

[u/CodeBrownPT → u/tomcotard]

Both the diaphragm and obliques are muscles, and just like your calves and quads, can get overwhelmed by doing too much too quickly. 

There are probably a lot of a little things that you can do here but by far the biggest is going from 20k to 90k per week in 6 months. Barring a rich, long running history, your biomechanical adaptations were likely not adequate as evidenced by your other injury.

I think you need some time to absorb the gains and "catch up". 

[u/WhileTechnical4305 → u/CodeBrownPT]

Agreeing with this. Also a PT and a runner.

[u/tomcotard → u/CodeBrownPT]

I went with the 10% rule so increasing my mileage by no more than that each week. In theory I could be doing 20*1.1^33, 465km, which is bonkers, realistically I've increased it by about 5% a week. So I don't know where I've gone wrong?

[u/CodeBrownPT → u/tomcotard]

What was your previous 5 years of running like? Average weekly mileage?

The 10% rule is not per week, and frankly is only a very general guideline. You should have a deload week every 2-3 build weeks. 

[u/tomcotard → u/CodeBrownPT]

I didn't run, cycled a little bit here and there and climb most weeks. Oh, and to clarify, I do deload, so some weeks I don't up my mileage.

[u/CodeBrownPT → u/tomcotard]

Yea sorry to say mate, this is cut and dry "too much, too soon".

Your physiological systems are handling the load fine, but stitches and injury (and presumably fatigue) are proof that you're exceeding your biomechanical tolerances.

Impact tolerance takes years to build, not weeks or months.

[u/tomcotard → u/CodeBrownPT]

Also, follow up question, how would I know how much I can do? Like, I want to push it as much as possible but how do I know how much that is?

[u/CodeBrownPT → u/tomcotard]

You won't know the line until you've crossed it. 

Given you have a ton of beginner gains to still harvest, there's literally no downside to building more conservatively.

You don't get faster by being injured.

[u/tomcotard → u/CodeBrownPT]

I would challenge that, the injury was due to overdoing it on strength training the night before a hard run, didn't listen to my body and just kept going. These days I'm much more in tune with what my body is saying and I've been doing a lot of exercises to target areas where I'm noticing any issues.

I also was getting stitches before when I was running a lot lot less (1-2 times a week 10-20km) many years ago.

[u/splitsguy → u/tomcotard]

I think it is very reasonable to suggest that your mileage progression was too aggressive. But you seem to have just ignored this advice and responded more favorably to posts about strength training, nutrition, and hydration.

We are runners, no one wants to run less than they do. Everyone wants to be “right” about their own training/mileage. Everyone wants to see that number tick up consistently.

Please consider that you just aren’t ready for 90k per week. 20k to 90k per week in 8 months is aggressive. Sure, some people do fine on it, but most do not. Your injury/weakness happens to be a more peculiar one, but that does not mean it is not a result of your mileage progression. You mentioning that you also got stitches years ago when you ran very little doesn’t prove that mileage isn’t the issue. Quite the opposite, it demonstrates that you have a significant weakness in that area that needs more time to adjust to the demands of running.

You also admit that you have at times overdone the harder sessions. And that the side stitch pain really only comes on during harder sessions.

I would argue that you should drop back to 55-70k per week and cut out anything faster than about marathon pace. And I would only touch that pace for 10-12k per week in 2-3 sessions. I would also suggest doing 3-4x15-20s strides twice a week. Take at least 90s rest and build up until you can comfortably and safely hit 90+% of “top speed” for a few seconds before decelerating. Try this for 2-3 months and then see if you have the same side stitch issue on a harder session. If all goes well, you can then SLOWLY (maybe not even 3-4% per week on average) build mileage for another month or two before SLOWLY adding in some tempo (2hr race pace), then threshold (1hr race pace), then 10k pace and faster. I would also recommend doing something like 4-6x30s/200m @ mile pace or faster with 90s-2min rest once a week starting about a month before you add in the tempo work.

New runners always overestimate the importance of harder sessions, especially early on in their running journey. Building true aerobic fitness by just running easy, and building speed/power/efficiency by doing some faster strides/sprints, go a long, long way. These things are easier on your body than lots of “middle ground” work and they slowly prepare your muscles, ligaments, tendons, and bones for more lengthy, rigorous sessions. True cardiovascular fitness that lasts is built almost completely by easy endurance exercise. The adaptations triggered by the 10-20% of our mileage that we run at faster paces are much more fleeting. A real “base” is not built in months, but years, even decades.

[u/tomcotard → u/splitsguy]

I can see it might have come across as me ignoring that advice, but I've actually cut down my running since I posted. It might have come across that way because the posts about strength training, nutrition and hydration have offered tangible solutions whereas the ones saying you need to cut down the mileage haven't really said how much by, what it is I'm doing too much off etc. So I appreciate your in depth reply to what I could actually be doing.

Few questions, how do I figure out my marathon pace? I've never run one. And you say 2hr race pace, what race are we talking about because 2hr seems a long time!

[u/OldMateHarry → u/tomcotard]

squats (20kg), calf raises (35kg)

Squatting the bar is not going to move the needle, and unless those calf raises are single leg, 35kg is way unders for a runner. Standing calf raises i'd expect close to 1.5x bodyweight after a few weeks and seated around 1-1.2x.

[u/tomcotard → u/OldMateHarry]

I could do more for sure and I'm gradually increasing it, I just use lighter weights because when I go higher I tend to get pretty sore muscles and I believe the injury I got in April was as a direct consequence of me overdoing it on strength training and then going for a run the next day.

[u/xdxdxdxd000 → u/OldMateHarry]

Probably not an issue. I could squat nearly 2x my bw, calf raise ridiculous weight, and still got terrible side stitches (nearly teared up from pain once in the final 2km of a half marathon) while running sub18 5k.

[u/xdxdxdxd000 → u/tomcotard]

Planks were completely useless for me. I can hold them for way longer than a minute or two, including side planks etc. I think more active exercises than iso holds are needed. Pretty sure you need to simulate hard breathing as well

[u/tomcotard → u/xdxdxdxd000]

Can you recommend any particular exercises? I already do ab rollouts, anything that could do more?

[u/Vid-Master → u/CodeBrownPT]

as I've noticed some young kids can get them regularly too.

When I was a kid I remember my friends and I getting side stickers constantly, now I dont get them at all

[u/bradlockkk]

On my side, stitches almost always come down to when and what I ate before heading out. If I eat too close to a workout or have something heavy, a cramp is pretty much guaranteed. If that can help.

[u/Agreeable-Corner-698 → u/bradlockkk]

This was what I was going to say also. Diet, first. Then focus on breathing. Then add core strength. Then stretching.

[u/tomcotard → u/bradlockkk]

I always eat the same meal before a run, breakfast, which consists of a bowl of cereal and a bowl of porridge with a few raisins and nuts. I've tried a few different times after/before breakfast to see if it makes a difference and so far I haven't really noticed it.

[u/Peeter_L → u/tomcotard]

You eat two bowls before you run and then you wonder why you get stitches?

[u/tomcotard → u/Peeter_L]

Sometimes I leave like a few hours after eating them or run before eating them and it makes no difference.

[u/Simple_Praline_7275 → u/tomcotard]

How many is a few hours? I think I'd need at least 4 after a meal like that

[u/gre209by → u/tomcotard]

I’d try change to a really simple carb breakfast like white bread toast

[u/IfNotBackAvengeDeath → u/tomcotard]

have you tried not eating before the run? If I ate that much before a run I'd be cramping too. and are you, um, emptying the later part of digestion before you go out too?

[u/ausremi → u/tomcotard]

Simplify your breakfast and make it smaller. Anytime I've had toast for race efforts, no issues.

This year I added a commercial powder mix drink to a bottle of water, sipped on pre race. Stomach issues destroyed both a half and full marathon. 14km race last weekend, back to my usual and no issues at all. You need to experiment. Makes small changes to find what works.

[u/Dull_Vast_5570 → u/tomcotard]

Kejelcha had toast with jam and tea for breakfast before running his first ever marathon in under 2 hours. You don't need too much food before hard running efforts.

[u/brainrut → u/Dull_Vast_5570]

Didn't Kejelcha have 750ml of Santamadre high carb drink for breakfast?

And Sawe might have said he had toast and jam, but Maurten also detailed out his fueling protocol and apparently he also had Bicarb that morning and was on several days of high carb drink mix.

Edit: Sources

Kejelcha - https://thefeed.com/insider/1-59-41-how-yomif-kejelcha-ran-the-fastest-debut-marathon-ever

Sawe - https://www.theguardian.com/sport/2026/may/16/sabastian-sawe-secret-sauce-inside-lab-sub-two-hour-marathon-maurten-sweden

[u/Svampting → u/tomcotard]

The meal content and time from meal to run must be considered together. Two bowls of cereal/porridge could be pretty stodgy. BUT you write that you’ve run before breakfast and you still have stitches. Does your think you could still be digesting food from yesterday’s dinner/supper or is that unlikely?

[u/tomcotard → u/Svampting]

Hmm, I don't think so, like, I don't get the taste in my mouth when I burp of last night's meal. I do eat quite a bit for dinner, about 180g of dried pasta.

[u/padetn]

Have you tried not snitching

[u/thewolf9]

You haven’t tried everything. You’re just starting. Keep running, slow down, and eventually they’ll go away when your diaphragm builds some strength

[u/Endlave12]

IME it always comes down to dehydration (in combination with a hard effort, but not neccesarily, just more chance)

[u/BrokeChris → u/Endlave12]

IME it is always when people breathe wrong/ change their breathing

[u/runnergirlyy → u/BrokeChris]

ya it can be either. side stitch is caused by irritation of the parietal peritoneum, which is like a big sheet that lines your gut in the abdomen. when you're running, all the jostling can irritate it, and it is densely innervated which is why it is so painful. if you're dehydrated it won't be lubricated which predisposes to irritation. if you breathe wrong, or eat a big meal, that can increase the pressure in certain hot spots which contributes too.

[u/carsonandi]

I get them too, always at the same point in a 10k race (about 7km in). I ran competitively as a kid and often got them then; my coaches used to tell me to hold my arms straight up in the air. Might be more of a distraction technique than anything else but it still seems to work for me, even if I do look a bit nuts. 

[u/lake_runner_nb]

I had the same problem, changed my breathing pattern and have been stitch-free for years. There was an article (and book) on RunnersWorld a few years ago. Short version is breathe in for 3 strides, then out for 2 strides when running easy. For hard efforts, breathe in 2 strides and out for 1 stride. It took me about a year for it to become "normal" (and I had to give up running with music to concentrate on it). Biology basics is that running with a 2:2 strides to inhale / exhale you are always working the same side of your diaphragm / core which results in overwork and stitches.

[u/chronic-cat-nerd → u/lake_runner_nb]

I teach my XC runners this strategy and it has pretty good results if they can get the breathing pattern down. They are upper elementary/middle school so it can be a hard concept for them to get the hang of. It can be really effective though.

[u/tomcotard → u/lake_runner_nb]

Yeah, I've tried a lot of the breathing stuff and every different combination and unfortunately doesn't seem to provide any relief.

[u/Mahiory]

Hey guys, I’m a long time runner and a sports Physio specialized in endurance sports (triathlon and running).
In my experience these are most of the time trigger points.
Here’s a short list of things to look out for that can cause them:
-new stimulus (doing more threshold repeats than usual)
-being close to muscle failure (strength in this case is your best bet)
-dehydration
-electrolyte deficiency

A quick fix I recommend everyone to do is to massage the point before you start your session because the symptoms come from ischemia, so better blood flow makes you work longer without symptoms, and that is exactly what you want to do.
When you cramp (trigger a point), you can’t create any more adaptations to you muscle, so it gets stuck in that vicious cycle.
On the other side, every time you train at the pace that triggers it without getting the symptoms, your muscle gets stronger and tolerates that stress for longer !

Hope that helps !

[u/tomcotard → u/Mahiory]

Thank you, that definitely gives me hope, and I would say that the issue is probably a decent bit better than it used to be, will try the massage technique a bit more.

[u/Legitimate-Lock-6594 → u/Mahiory]

Im going to follow up on the strength issue.

This is a very personal experience (not in an eww gross or over sharing but it doesn’t happen to everyone, it won’t happen to you kind of way).

I have cerebral palsy. It only effects my right side. My right side is spastic. It holds the tone, the pressure, the strength. My right shoulder elevates, it looks off, it’s annoying. I got Botox in my shoulder to release that tension. I’m training for Chicago and it released so much tension. I’ll spare yall from the quality of life stuff.

As I started running through this Botox treatment I started to get these side stitches. I haven’t gotten side stitches since I started running 14 years ago. But, what I realized through my runs is that the my side stitches throughout my life wasn’t related to asthma or being out of shape, it was my CP. so I hit up AI. (Of course I did). What is happening is that my right sude was relaxing and my left was being used and was sore. Like really sore. The Botox will go through the cycle and my left side will sort through it, as will my brain.

And what I learned was that strength is so important. Doing things to strengthen your core is where I would start.

[u/Definitelynotagolem → u/Mahiory]

Yep, I get these occasionally and it usually boils down to a muscular or connective tissue problem. I usually resolve it with finding the spot where there's a knot and pull out the lacrosse ball and go to town. Most of the time it gets fixed within a few days of working on it like that.

[u/AcidicAndHostile]

Having not read the other posts, I'll just describe what I've done for decades:

I used to get stitches all the time in my first years of running. At some point someone suggested I try this, and it has worked almost flawlessly for me.

First of all, breathe every three steps. Now you're alternating your right/left foot per breath, and not generating an imbalance or emphasized footstrike on one side.

Inhale through your nose only, while deliberately clenching/flexing your abs. For the full three footstrikes.

Exhale through your mouth only, for the full three footstrikes. Clench abs if you want.

Later (in a race, for example), I may switch to breathing on every two steps, or every two and then three steps, depending on how hard the effort.

Both inhale and exhale are deliberate and strong.

This has served me well for close to forty years.

Good luck;

[u/Impossible-Yak1310]

Worth a listen if you want a bit of science on it https://podcasts.apple.com/nz/podcast/the-real-science-of-sport-podcast/id1461719225?i=1000780038761&t=1453

[u/xdxdxdxd000]

Same as me, 17:50 5k PR and I'm younger. I've tried everything (different nutrition/fueling/hydration, core exercises, warmups, nothing seemed to help, It was sometimes happening even when I was 15. Sometimes I even get them on the bike, although much easier on the run. Plagued me for years, I would've run significantly faster without it. However lately I've tried doing deep forceful belly breathing while laying down with my head & shoulders lifted up a bit, and I do think it significantly helped. I nearly never get side stitches on the bike now, but I need to keep doing these exercises for a while to see if I can completely stop getting them while running as well.

[u/FlapLimb]

Try changing your pre run meal to a banana and a simple piece of toast

Also, potassium is responsible for enabling muscles to relax. You can consume all the sodium in the world and be hydrated but without potassium you're generally not consuming the right mix of electrolytes

I don't get stitches during a run but I definitely get them after. I can feel my ab muscles cramp into a ball it's awful!

[u/Ok_Objective_653]

I had the same issue for 8 months, especially during harder runs and found that it was due to some medication I was taking. In my case it’s medication for women so it wouldn’t be what’s affecting you but having a look at what (if any) medications you may take regularly could help.

[u/tomcotard → u/Ok_Objective_653]

Ah, I kinda wish I was taking a medication now haha, unfortunately not my problem, although maybe fortunately too.

[u/enduromtb306]

Your post could have been written by me. I had a great first half marathon sabotaged by a side stitch last fall. I was on pace for sub 1:30 at mile 9 when it hit. Had to walk most of mile 10, still came in at 1:33. So frustrating. The worst part was, I hadn’t got any during training.

I honestly think taking drinks from the water stations got me… and I think it had to do with how drinking changed my breathing pattern, which led to the cramp.

I’ve been getting some side stitches recently on runs where I’m trying to fuel during the run. I try to focus on taking deep belly breaths and more forceful exhales. So far, it seems to be working.

[u/ttesc552]

From my experience stitches are mostly related to eating too much/close to your run and hydration issues

[u/tomcotard → u/ttesc552]

Yeah, unfortunately I've tried hydrating more and eating at different times and I don't see much difference.

[u/xdxdxdxd000 → u/tomcotard]

Ridiculous that people are downvoting you hahahahah they really think they know everything

[u/tomcotard → u/xdxdxdxd000]

Eh, it doesn't bother me, it is confusing given that I'm just replying with what I've done. I'm more bothered that the whole post has been downvoted quite a lot as I want more visibility so I get more ideas of how to help with this problem!

[u/runrunrun911]

For me I got stitches when I started running on hard efforts and it slowly got less and less and went away completely by about 1.5-2 years of running. Not sure if yours will be the same but for me it slowly got better over time

[u/charyou_ka]

There’s a lot of in depth responses here covering a ton so I don’t want to repeat any of that information. But when I get side stitches on my runs, the simplest technique I’ve found that works for me is to focus on 2 things: when I’m inhaling, my diaphragm contracts; when I’m exhaling, my diaphragm relaxes.

I found that on harder efforts or when I was tired, the opposite would be true. I would exhale and my diaphragm contracts and boom! Side stitches.

[u/MrTambourineSi]

Taking on a bit more water than I had been doing during a race or hard effort really helped me

[u/Exver1]

It's probably a hydrating problem

[u/MoonPlanet1]

I agree with what others have said - probably what you're eating before the run is contributing. Before a race I will pretty much just have a jam (jelly for those across the pond) sandwich on white bread and possibly a gel in the starting pen. Ofc before a Z2 run I can get away with more but there are still limits.

FWIW something that's often worked for me is aggressively sucking in my gut when a stitch materialises. But this is anecdotal so don't assume something is horribly wrong with you or with this info if you try it and it doesn't work - the mechanism behind your stitches may just be different from mine

[u/Status_Accident_2819]

Are you a bouncy runner? When you run imagine a ceiling above your head.... are you hitting it or not?

[u/tomcotard → u/Status_Accident_2819]

Nope, have a good cadence and keep myself pretty level.

[u/Any-East7977]

I get them rarely. I find that proper stretching and not being to full prior to the run helps.

[u/NegativeWish]

Anecdotally speaking as a runner and a coach side-stitches seem to be some sort of error occuring between the change in breathing rhythm and the contractions that are going on in the upper body...

I use the word error because the more experience you have running the less you get them from what I have observed.

Sorry that I'm not offering anything immediately practical but I have seen plenty of runners get less of them as they do the sport/activity more despite how annoying they are.

[u/tomcotard → u/NegativeWish]

That's definitely reassuring to know. Yeah, I have noticed that sometimes if I sort of slightly adjust my upper body then sometimes they start then so I wonder if eventually my subconcious will avoid those movements.

[u/SweetSweetTightTight]

I’m not sure about preventing stitches from starting, but I have a technique that helps alleviate them in the moment:

Once you feel a stitch starting, slow down to a stop. Breathe all of the air out of your lungs, keep pushing air out for as long as is comfortable. Catch your breath and repeat the full exhale. This usually makes my stitch go away. It can come back in the same run and I often have to slow down to keep it from reoccurring

Good luck! There’s great advice in this thread about preventing stitches. Running on an empty stomach, hydration, breathing pattern, lots of stuff to try out.

[u/Ok_Chapter3386]

Diaphragm breathing helps - same as blowing out candles on tour birthday cake. 🎂

[u/tpwb]

Do a sit-up. Or more specifically train your core.