A ‘stitch,’ medically known as exercise-related transient abdominal pain (ETAP), is a sudden, sharp pain in the side common among runners. This discomfort affects approximately 70 percent of runners annually. While its exact cause is debated, understanding it can help athletes manage and potentially avoid it.
Understanding the Sensation
A stitch typically manifests as localized pain along the lower ribs, most frequently on the right side, though it can occur on the left or centrally. The pain ranges from a mild ache to a sharp, stabbing sensation, sometimes extending to the tip of the shoulder. This pain is generally temporary and not indicative of a serious underlying health issue.
Leading Theories for Stitches
Several theories attempt to explain the cause of stitches. One prominent explanation involves irritation of the parietal peritoneum, a thin membrane lining the abdominal cavity. Repetitive torso motion during exercise, like running, may cause friction or stretching of this membrane, leading to pain.
Another theory suggests stress on ligaments connecting abdominal organs, such as the liver and spleen, to the diaphragm. The jolting motion of running can pull on these ligaments, causing strain. This may explain right-sided stitches, as the heavy liver is located there and can exert significant pull.
Diaphragmatic ischemia, a temporary lack of blood flow to the diaphragm muscle, is another potential cause. Increased demand during intense exercise can lead to insufficient oxygen supply, resulting in cramp-like pain. Digestive factors also play a role; eating large meals or certain beverages high in fat, fiber, or sugar too close to exercise can contribute to a stitch. This is because blood flow is diverted to the digestive system, reducing oxygen to the diaphragm. Electrolyte imbalances (sodium, potassium, calcium) have also been suggested as a contributing factor to muscle spasms.
Preventing a Stitch
To reduce the likelihood of a stitch, runners can employ several strategies. A proper warm-up, including dynamic movements, prepares the body and helps prevent rapid changes in breathing. Focusing on deep, diaphragmatic breathing, rather than shallow chest breathing, ensures adequate oxygen supply and supports the diaphragm.
Timing of nutrition and hydration is important. Avoiding large meals, especially those high in fat or fiber, for one to two hours before a run can reduce gastrointestinal strain. While staying hydrated is essential, consuming small sips of water rather than large volumes immediately before or during a run can prevent stomach bloating. Gradually increasing exercise intensity and avoiding sudden bursts of speed can also help the body adjust and minimize stress on the diaphragm and abdominal ligaments. Strengthening core muscles can also provide better support for the trunk, potentially reducing strain on the abdominal area during running.
Alleviating a Stitch
If a stitch occurs during a run, several immediate actions can help alleviate discomfort. Slowing down or stopping the activity provides immediate relief, allowing the diaphragm to rest. Practicing deep, controlled ‘belly breathing’ helps by fully expanding the lungs and encouraging the diaphragm to move freely. Some runners find relief by exhaling forcefully as the foot opposite the side of the stitch hits the ground.
Gentle stretching can also be effective. Reaching the arm on the side opposite the pain overhead and bending towards the side of the stitch can stretch the affected abdominal muscles. Applying gentle pressure to the painful area with your fingers while breathing deeply can also help ease the cramp. If the pain persists, or if a stitch occurs when not exercising, consult a medical professional to rule out other conditions.