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Cramp & Stitch

Everybody knows what a stitch is, right? And everybody knows what it feels like to get cramp? Strangely though, we actually don’t know too much about what these two phenomenon’s are, or what causes them…

Lets look at what we do know;


Side stitches are a very common problem among runners. They are mostly felt in the side, and make it difficult to breathe when exercising as it feels like someone is stabbing you in your side! Occasionally, they will be accompanied by pain at the tip of the shoulder on the same side. But as I have said, the actual cause of a stitch is still uncertain.

There are various ideas and opinions, all of which have some evidence to support them…and some to dispel them. Traditionally, it was thought that a lack of blood flow to the diaphragm can cause irritation and pain. However, studies have shown this not to be the case (Ref 1).

Another explanation for cause of stitch is irritation of the ligaments and soft tissues which connect all of the various muscles, bones, and organs inside the abdomen. The theory goes, impact during activity pulls the organs in your abdomen downwards, tugging on the ligaments in the upper abdomen and eventually creating irritation. This would make sense of why eating a meal too close to exercising seems to correlate with a stitch. However, this doesn’t stand up to research either! (Ref 2).

So how can you avoid getting a stitch? Studies have established that eating a large meal or drinking concentrated, sugary fluids like fruit juice close to the time of the exercise will increase your risk of developing a stitch, and they certainly seem to correlate with when you eat. If you are a chronic sufferer of the dreaded stitch, try keeping a food diary before exercise.

Diaphragmatic Breathing exercises may help to strengthen your breathing, as the diaphragm is a muscle (albeit involuntary), and how hard you are exerting yourself certainly seems to correlate with  getting a stitch; you may also want to consider incorporating some S&C for your hip flexors and extensors, ensuring a good, strong upright position of the trunk.


Cramping is a common and usually harmless condition where muscles suddenly involuntarily contract, or shorten, and become tight. Harmless they may be, but they are (often) extremely painful. Most common in the legs, any runner will know the feeling well!

Similar to a stitch, the research into the cause of cramping is largely inconclusive. There are again, however, a couple of things at play.

Most often blamed is dehydration, or an electrolyte imbalance. However this seems to stem from marketing (of sports drinks) more than scientific research. Research has actually found no relation of any kind between an athlete’s electrolyte levels and their risk of cramping (Ref 3).

Exercise induced cramps seem to stem from neural mechanisms, which are designed to inhibit muscle contraction, being depressed and the chemical and electrical synapses that fire the muscle fibers being enhanced. The result is an intense, sustained involuntary muscle contraction – cramp!

How do we avoid this cramping? Hydration is important; our muscles are around 80% water, and a 2% drop in hydration level can result in a 10-20% decrease in performance. A 5% drop can lead to a 30%+ decline. Committed athletes will weigh themselves pre- and post-workout, and measure the weight loss. For every Kg lost in weight, we would ideally be replacing that with between 1 and 1.5 litres of fluids. There are companies that will measure your electrolyte loss too, but as discussed, the science is sketchy at best.

You would have to consider exactly which muscle groups are cramping, and look to what the output expectations of that muscle group are, compared to its capabilities. Involuntary contraction of a muscle (Muscle A) can often be traced to a different muscle group (Muscle B) not being strong enough to cope, and so sending workload to a muscle (Muscle A) with an ever lower capability. Ergo, strengthen Muscle B, and ease the workload of Muscle A, resulting in lower chance of cramping.

Taking a holistic approach, other things to consider are diet – are you eating enough vegetables, greens, fruit etc? There is some research (again, fairly inconclusive…) into potassium deficiency being at play with cramps, so dietary potassium could help.

There is also some discussion on magnesium deficiency. The theory here is that as magnesium plays a role in neuromuscular transmission and muscle contraction, deficiency may predispose to muscle cramps

With both Stitch and Cramp, it will take a little trial and error on an individual level to find the exact cause (if there is a singular cause) – let me know how you get on!


  1. Morton, D.; Callister, R., Spirometry measurements during an episode of exercise-related transient abdominal pain. International Journal of Sports Physiology and Performance 2006
  2. Morton, D.; Aragón-vargas, L.; Callister, R., Effect of ingested fluid composition on exercise-related transient abdominal pain. International Journal of Sport Nutrition and Exercise Metabolism 2004
  3. Brouns F, Beckers E, Wagenmakers AJ, Saris WH. Ammonia accumulation during highly intensive long-lasting cycling: individual observations. Int J Sports Med. 1990

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.

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