Side stitch
Encyclopedia
A side stitch is an intense stabbing pain
under the lower edge of the ribcage that occurs while exercising. It is also referred to as exercise related transient abdominal pain (ETAP). Some people think that this abdominal pain
may be caused by the internal organs (like the liver
and stomach
) pulling downwards on the diaphragm, but that theory is inconsistent with the fact that it frequently occurs in swimming
, which involves almost no downward force on these organs. If the pain is present only when exercising and is completely absent at rest, in an otherwise healthy person, it is benign and does not require investigation. There are a variety of published ways of alleviating the symptoms including adjusting at what point in your stride you inhale.
ligaments due to repeated vertical translation and jolting. Such theories include:
The reasons for the variety of theories include, in particular, the prevalence of ETAP during swimming.
Most of the time, side stitches occur on the right side of the body. This may be because the largest organ in the abdominal cavity, the liver
, is on that side. Certain athletes also report a pain in the tip of their shoulder blade. This is believed to be because this is a referred site
of pain for the diaphragm via the phrenic nerve. When the side stitch is on the right side, published advice is to try to exhale when your left foot lands.
Alternative cures are listed and exist in much the same context as the cure for hiccups;
These alternatives work by implementing the aforementioned function in combination with a coordinated task to occupy the sufferer's mind.
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
under the lower edge of the ribcage that occurs while exercising. It is also referred to as exercise related transient abdominal pain (ETAP). Some people think that this abdominal pain
Abdominal pain
Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...
may be caused by the internal organs (like the liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
and stomach
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
) pulling downwards on the diaphragm, but that theory is inconsistent with the fact that it frequently occurs in swimming
Swimming (sport)
Swimming is a sport governed by the Fédération Internationale de Natation .-History: Competitive swimming in Europe began around 1800 BCE, mostly in the form of the freestyle. In 1873 Steve Bowyer introduced the trudgen to Western swimming competitions, after copying the front crawl used by Native...
, which involves almost no downward force on these organs. If the pain is present only when exercising and is completely absent at rest, in an otherwise healthy person, it is benign and does not require investigation. There are a variety of published ways of alleviating the symptoms including adjusting at what point in your stride you inhale.
Causes
There are other theories regarding side stitches than simple stretching of the visceralViscus
In anatomy, a viscus is an internal organ, and viscera is the plural form. The viscera, when removed from a butchered animal, are known collectively as offal...
ligaments due to repeated vertical translation and jolting. Such theories include:
- The pain may be caused by contracting the liver or spleen, which squeeze extra oxygen-carrying red blood cells into the circulation. Although there does not appear to be much muscle in the capsule of the spleen, there is direct and indirect evidence that its size does change with exercise. (see ref} below) This autotransfusion, (which is much larger in some animals) increases exercise capacity but the associated pain may be severe, relieved only by rest. A plausible mechanism for the pain is that high internal pressure in the liver or spleen restricts blood flow, causing hypoxia.
- Diaphragmatic IschemiaIschemiaIn medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
- Imbalances of the thoracic spineThoracic vertebraeIn human anatomy, twelve thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. They are intermediate in size between those of the cervical and lumbar regions; they increase in size as one proceeds down the spine, the upper...
- Irritation of the parietal peritoneumPeritoneumThe peritoneum is the serous membrane that forms the lining of the abdominal cavity or the coelom — it covers most of the intra-abdominal organs — in amniotes and some invertebrates...
The reasons for the variety of theories include, in particular, the prevalence of ETAP during swimming.
Most of the time, side stitches occur on the right side of the body. This may be because the largest organ in the abdominal cavity, the liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
, is on that side. Certain athletes also report a pain in the tip of their shoulder blade. This is believed to be because this is a referred site
Referred pain
Referred pain is pain perceived at a location other than the site of the painful stimulus. An example is the case of ischemia brought on by a myocardial infarction , where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the injury...
of pain for the diaphragm via the phrenic nerve. When the side stitch is on the right side, published advice is to try to exhale when your left foot lands.
Prevention
- Drink water or fluids. Dehydration is a common cause of side stitches.
- Improve fitness
- Strengthen the diaphragm by using exercises such as those that aid respiratory rehabilitation
- Strengthen core muscles (abdominalsAbdomenIn vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
, lower back, obliques) - Limit consumption of food and drink, two to three hours before exercising (in particular, drinks of high carbohydrateCarbohydrateA carbohydrate is an organic compound with the empirical formula ; that is, consists only of carbon, hydrogen, and oxygen, with a hydrogen:oxygen atom ratio of 2:1 . However, there are exceptions to this. One common example would be deoxyribose, a component of DNA, which has the empirical...
content and osmolarity (reconstituted fruit juices)) - Drink water beforehand to prevent muscle cramps
- Warm upWarming upA warm-up is usually performed before participating in technical sports or exercising. A warm-up generally consists of a gradual increase in intensity in physical activity , a joint mobility exercise, stretching and a sport related activity. For example, before running or playing an intense sport...
properly - Gradually increase exercise intensity when runningRunningRunning is a means of terrestrial locomotion allowing humans and other animals to move rapidly on foot. It is simply defined in athletics terms as a gait in which at regular points during the running cycle both feet are off the ground...
- Run on soft surfaces
- Deep breathing with full exhalation
- Slow the pace of the exercise.
Treatment
Pain induced by the stretching of the visceral ligaments is relieved by removing or minimizing the applied force, by slowing or stopping the exercise and lying down until the pain subsides.Alternative cures are listed and exist in much the same context as the cure for hiccups;
- Stop exercising. With the digits, push into the abdomen on the right side, and up under the rib cage. At the same time, forcefully let out a deep exhale while holding the lips closely together.
- Try belly breathing; inhale while pushing out the stomach, and on the exhale, relax the stomach muscles.
- While running, exhale when your foot strikes on the opposite side that the side stitch is located. For example, a side stitch on the right, exhale hard when your left foot strikes the ground.
- Reduce the frequency of breathing (e.g. in jogging, inhale for four steps and exhale for three steps)
- Lie down on the back and lift the knee on the side with the stitch up to the chest.
- Do not breathe too hard, shallow breathing for a few minutes at the same time maintain oxygen input levels.
- Relax the mind and do not focus on the stitch itself.
- Put pressure on the affected area, not enough to hurt, but just enough so the pain subsides.
- Stretch the chest wall and back, whilst laying on your stomach and arching your back.
- Suck in your stomach (like when you are trying to look thinner), it puts pressure in the right places instead of applying pressure with your hand. A side stitch free jog may be maintainable.
These alternatives work by implementing the aforementioned function in combination with a coordinated task to occupy the sufferer's mind.