Stitches: a real pain in the side

author

Luke Nelson

Chiropractor, Director of Health & High Performance, Fellow Sports & Exercise Chiropractor (AICE 2019)

The dreaded side stitch, it feels like it can attack at any time, and often results in the sufferer, gasping for air and keeling over in pain! Not only do they hurt, but your performance can suffer as a result! So what are “stitches”? What can you do to relieve them? And what can you do to prevent them?

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Also known by the medical name of Exercise-related transient abdominal pain (ETAP), the sharp, stabbing, or cramping pain is usually felt in the mid-outside abdomen near the ribs, although it can occur in any region of the abdomen. Rarely they can also give pain in the tip of the shoulder.

Approximately 70% of runners report experiencing the pain in the past year and in a single running event approximately one in five participants can be expected to suffer the condition, so no doubt many of you have suffered this affliction! (Morton, D et al 2015) . Even well-trained runners and athletes are not immune from this condition, although they tend to experience them less frequently.

What causes stitches?

Whilst the exact cause is often unknown, some of the leading theories include ischemia (lack of blood supply) to the intestines, irritation to the intercostal nerves (potentially aggravated by poor posture), irritation to the parietal peritoneum (tissue covering the inside of the abdomen)

How to prevent side stitches?

  • Nutrient Timing: Avoid eating large meals, fatty foods or dairy products 1-2 hours before exercise (Morton et al 2005). Also avoid large volumes of fluid, especially high carbohydrate, carbonated drinks (Morton et al 2004)
  • Breathing: exercises designed to promote belly breathing (rather than chest breathing) may help
  • Thoracic mobility: warming up prior to running with some exercises designed to improve movement in the mid-back (Morton et al 2004). Check out some of our top exercises to improve your mid-back mobility in the video below. Manual therapy may also assist improve thoracic mobility.

  • Improving fitness: whilst still occurring in fitter individuals, stitches are less common.
  • Getting older: not something you can just do, but stitches actually become less prevalent as you age. Author McCrory comically advocated “grow old, as stitches are less common with aging”. (McCrory 2007).

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What to do if you get a stitch?

So there are a number of things that you can try when you get a stitch to try and relieve it:

  1. Take some slow deep breaths, focusing on breathing into the abdomen and not the chest. Try breathing through pursed lips to also encourage this.
  2. Try and stretch the painful area
  3. Bend forwards
  4. Push on the sore spot
  5. If all else fails then you may need to stop exercising!

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So whilst the exact cause of your stitch may not be able to be identified, there are a number of things that you can do to prevent them, and if they happen to still come on, try the relieving techniques identified above.

This was originally posted on Luke Nelson’s website. You can click here to read more blogs from him.

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About the Author

author

Luke Nelson

Chiropractor, Director of Health & High Performance, Fellow Sports & Exercise Chiropractor (AICE 2019)

After graduating from RMIT in 2003, Luke went into private practice, founding Chiropractic Solutions in Bentleigh East. After 15 years, it was time to move on to the next challenge, which saw him found Health & High Performance in Mont Albert North. ​ His vision is to provide high-quality healthcare to help keep active individuals and athletes doing what they love! ​ Luke's special interest in treating sporting injuries (soft tissue injuries, ankle sprains, ACL injuries, shoulder pain) and in particular running injuries (knee pain, ITB, achilles pain, plantar heel pain). His unique approach takes a variety of different assessments and treatment techniques to get to the source of your problems and get you back on track. ​ In 2016, Luke was awarded the Australian Chiropractic Association's "Sports Chiropractor of the year" for his contributions to the field of Sports Chiropractic.

References

  • McCrory, P. (2007). “A stitch in time.” Br J Sports Med 41(3): 125.
  • Mole, J. L., et al. (2013). “The effect of transversus abdominis activation on exercise-related transient abdominal pain.” J Sci Med Sport.
  • Morton, D. and R. Callister (2015). “Exercise-related transient abdominal pain (ETAP).” Sports Med 45(1): 23-35.
  • Morton, D. P. and R. Callister (2008). “EMG activity is not elevated during exercise-related transient abdominal pain.” Journal of Science and Medicine in Sport 11(6): 569-574.
  • Morton, D. P., et al. (2005). “Epidemlology of exercise-related transient abdominal pain at the Sydney City to Surf community run.” J Sci Med Sport 8(2): 152-162.
  • Morton, D. P., et al. (2004). “Effect of ingested fluid composition on exercise-related transient abdominal pain.” Int J Sport Nutr Exerc Metab 14(2): 197-208.
  • Morton, D. P. and T. Aune (2004). “Runner’s stitch and the thoracic spine.” Br J Sports Med 38(2): 240.

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