From Dr. Natalie Meiri’s Clinical Pearl Stories: Exercise-Related Transient Abdominal Pain:

Runner’s Side Stitch and Chiropractic Care


This was a 35 year old patient with left sided back and rib pain of  1 month duration.  He also had a chronic problem he called a “side stitch”.  To be HIPPA compliant, I will call him Roger instead of his real name.   


Roger was a new runner. He started running various races about 6 months ago. Roger had suffered from runners “side stitches” during his training.  This time, he could pinpoint most of the pain to his left lower rib. Additionally, he had the all familiar chronic side stitch pain a few times a week during his runs. And he had no history of trauma. Furthermore, he had difficulty turning and twisting due to the rib pain.  Also, Roger stated discomfort with deep breaths.  He had been to his family doctor in case it was something more than musculoskeletal. 


What is Exercise-related transient abdominal pain (Runner’s stitch)?


Exercise related transient abdominal pain is a painful cramping or stabbing pain that is experienced by a runner.  It typically starts during the running activity.  It is usually felt most sharply under the rib cage, in the area of the diaphragm (located below the lungs, this is a major muscle of respiration) and upper abdomen (belly). Many athletes also report shoulder tip pain.


 Runner’s stitch can be a very painful physical problem. There are many explanations as to its cause:


  1. Stress is placed on the connective tissues and tendon that support the diaphragm through movement. So the connective tissues may become stressed when the runner has been breathing quickly. In other words, introducing short or shallow breaths into the lungs causes the connective tissues and diaphragm muscles to become stressed. And there is cramping or muscle spasm directly within the muscles of the diaphragm as well.
  2. It is also possible that running will particularly affect the ligaments and connective tissue that hold the organs (e.g. liver) in place relative to the diaphragm. The repetitive bouncing motion created by the running stride creates undue tension on these ligaments and connective tissue.
  3. Consumption of food within one hour of a race or training workout can cause the side stitch. A large volume of blood is pumped to muscles during exercise. Therefore, blood flow to the digestive processes (stomach) is decreased.  The result could be cramping in the muscles or an upset stomach.



Roger’s examination:

Upon examination, I found positive tests for a left 9th rib subluxation (chiropractic misalignment of rib articulation), myofascial (muscle) dysfunction and  thoracolumbar (mid to low back)  joint dysfunction (chiropractic misalignment). Roger’s condition did not require a x-ray.


Roger’s Treatment


Firstly, Roger’s treatment included chiropractic adjustments/manipulation to his subluxated rib and associated regions.  Associated regions were his thoracolumbar spine (mid and low back). 

Secondly, soft tissue therapy (myofascial release, pressure point and various post isometric relaxation procedures) was applied to the muscles involved.  For example, scalenes, and serratus posterior and superior muscles, internal intercostal muscles, abdominal muscles, quadratus lumborum and diaphragm.

Thirdly, therapeutic stretching  exercises were given to do before and after his runs. 

Fourthly, Roger altered his breathing pattern to deep regular breaths during running instead of short, shallow breaths. 

Fifthly, as with any other type of muscle difficulty, the overall strength of the abdominal muscles may contribute to the formation of a runner’s stitch.  So Roger worked to improve his overall fitness as the best prevention for runner’s stitch. As a consequence, he incorporated some strengthening of core muscle groups of his back and abdomen at the gym.

Lastly, Roger worked on maintaining better hydration and electrolyte balance.  And there were no dietary triggers causing his side stitches he could recall.

Dr, Meiri adjusts a patient


Roger’s Outcome from Treatment at Meiri Chiropractic

Roger felt much better from the first treatment.  And after only a few visits, his pain level and functioning was much improved. The side stitches never returned either.

Thereafter, he continued his chiropractic care with full spine adjustments regularly for overall wellness and increased performance as a runner. 

Over time, Roger’s posture also improved significantly with chiropractic care.  Running with poor posture constricts the expansion of the rib cage while breathing which contributes to the occurrence of runner’s side stitches.


Exercise-Related Transient Abdominal Pain: Runner’s Side Stitch and Chiropractic Care at Meiri Chiropractic in West Palm Beach


Chiropractic is for people who want to move and perform better in life. Chiropractic is for patients who don’t want drugs or surgery. Ultimately, it’s not just for pain relief.  It’s for those who want a better quality of life. Do you know someone with Exercise-Related Transient Abdominal Pain (side stitch)? Meiri Chiropractic serving West Palm Beach, Jupiter, North Palm Beach, and Palm Beach Gardens can help ease your pain. Call 561-253-8984 today to schedule an appointment or to learn more about Exercise-Related Transient Abdominal Pain: Runner’s Side Stitch and Chiropractic Care.



Exercise related transient abdominal pain: a case report and review of the literature
Dr. Brad Muir, HBSc(Kin), DC, FCCSS(C)*

J Can Chiropr Assoc 2009; 53(4) pg.251