Side Stitch type issue that has gone on for way too long!


I have been dealing with a side stitch type pain on my right side for close to a year now. It began late spring of 2022 during some hard 20 min type efforts. Prior to this I never had any side stitch type pain/cramps and have trained with hard intervals for 6-8 years. When I first experienced these issues I was in the middle of a 25 minute interval on a local MTB climb and pacing myself well. My max heart rate is mid 190’s and I find I can push hard for this length if I keep it below 180. About mid interval I was hit with what I would describe as a strong side stitch. I slowed down to a recovery level and it went away. I then continued the ride at an easy pace to save myself for another push later in the week.

Fast forward a few days and I try the same effort again and 5 minutes into the interval same results, moderately painful side stitch. I always warm up for 15-20 minutes. I took the rest of the ride easy and did not think anything of it. however the next day I had mild/pain irritation deep in my lower rib cage on the right side.

Fast forward again after resting for a few weeks this pain will not go away so I go see my primary care doctor. He pushes and prys on that area and thinks he can feel some muscle swelling or a small tear. He prescribes rest and for 2 months I ride 6-10 hours a week but limit it to very easy zone 2 type riding. I try and push hard after 2 months of rest and it came right back. Side stitch as soon as my heart rate stays in the 170 range for a few minutes. This is now late summer 2022 and I go see my doctor again. He recommends longer rest as this type of issue can take a long time to heal. I have taken his advice and stayed active but kept it easy for months and months.

Today I am still feeling irritation/pain in this area and my doctor has ordered a CT scan but does not seem optimistic it will show anything. It sounds like an ultrasound by a medical professional that really knows this muscle/skeletal structure of this area is what I need. What needs to happen is to be able to pinpoint the issue between rib cage and diaphragm as I think it’s a diaphragm injury/issue.

Anyone ever dealt with anything like this or heard about anything like this?

@bigdirt I’ve been dealing with this same issue the last 2 years. I notice that as I got fitter it went away, I usually started getting side cramps when I was above my body’s capability. It usually happens to me in a hard group ride like a race simulation ride. I did notice that it would come on when I was around 170ish HR as well. I personally was training at too low of a HR, my coach adjusted my threshold HR from 161 to 171 and I haven’t gotten side cramp as I trained at a slightly higher HR and got use to the load to my cardiovascular system. It would go away for me when I lowered my power to tempo or lower. I also have been taking calcium pills and adding more electrolytes to my drink but I think its a fittest thing. I hope you find out what is causing it for you cause it does suck and I have been battling with this as well this past year. I hope I found what personally works for me for this coming year.

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Proper imaging is overdue. Anything else is speculation.

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Above and see a proper doctor. One that specializes in sports medicine. They will get you back riding again.

Sharp pain on the inside of your ribcage (don’t really think it’s the ribs that hurt) when you try to take more than maybe 1/2 a breath? Just trying to clarify the symptom for everybody. If that is what you’re experiencing, I’ve had them from time to time my whole life. Seems very random, often not during exertion, usually just regular walking or sitting type activity.

Interested in if anyone has any info.

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I’d agree that it’s time for imaging. I did come across this brief mention of a side cramp in a recent Huberman podcast. Not sure if it helps.

Link to the youtube version is How To Build Endurance In Your Brain & Body | Huberman Lab Podcast #23 - YouTube

Time stamp is 01:32:10 Eliminating the “Side Cramp” With Physiological Sighs

Good luck.

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Side stitches are one of my weak points. I had my first really bad one during lockdown doing a virtual 5K going out WAY too hard (6:30-6:45/mi when I usually ran 7:15-7:30/mi for 5K). That searing pain in the ribs and barely being able to get a breath is horrible. Nowadays, I get it during some workouts and some Zwift races, but am usually able to work through it. I never saw a doctor about them, but it wouldn’t shock me if part of it is posture-related, for me at least. When I go too hard and forget to focus on posture and quality breathing is when I’m in for a bad time. Actually, I can feel the spot that gets mad is mad right now after doing my 30/15 outdoor intervals in a more aero position. Maybe some core strengthening would be a good idea to help fight this.

I always successfully eliminate my side stitches with the physiological sighs recommended by Huberman. I just did that some days ago after a long time with no side stitches.

I’d agree with everyone else that asking a medical pro is the proper thing to do. But, I will give a personal anecdote. A few years ago I had a string of failed 20 minute FTP tests due to pain in my side. I realized I had recently been drinking Powerade on my rides. The blue kind in powdered form (a local grocery store I liked sold this instead of gatorade powder).

I stopped using the powerade powder and the stitch in my side during hard efforts also stopped. I still don’t really know what exactly was going on, but something in that drink mix did me dirty.

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