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Stitch: A Real Pain in the Side

What is a stitch?

In the scientific literature stitches are referred to as Exercise-related Transient Abdominal Pain and are described as localised pain usually felt on the side, just below the ribs, which sometimes are accompanied by a stabbing sensation in the shoulder.

  • Stitch pain can range from sharp or stabbing to mild cramping, aching or pulling. Sometimes people can exercise through the pain, though usually the sufferer is forced to slow down or cease exercise.
  • Stitches usually disappear within a few minutes after ceasing exercise, however, some people experience some residual soreness for a few days.
  • Stitch seems to be more prevalent in activities that involve vigorous, upright, repetitive movement of the torso e.g. running, but it can occur in any type of sporting activity.

What causes stitches?

  • Scientists are unsure of the exact cause of stitch.
  • Most likely, stitch is caused by irritation of membranes in our lower abdomen. Two layers of membrane (peritoneum) line the inside wall of the abdominal cavity. One layer covers the abdominal organs, while the other layer (parietal peritoneum) attaches to the abdominal wall. The two layers are separated by lubricating fluid, which allows the two surfaces to move against each other without pain.
  • It is thought that the stitch occurs when there is friction between the abdominal contents and the stomach lining. This friction may be caused by a swollen (full) stomach or a reduction in the lubricating fluid. The lining of the stomach is also attached to the phrenic nerve, which refers pain to the shoulder tip region; this may explain the shoulder pain that has been described by some players.

How can I avoid stitch?

  • The liklihood of stitch occurring may be reduced by allowing two to four hours before exercising after a large meal and not eating fatty foods in the pre-game meal or before exercising. Eating too closely to game time seems to increase the chances of players experiencing a stitch.
  • High-fat and high fibre foods are more likely to cause problems.
  • Immediately before and during games, players should avoid consuming highly concentrated fluids such as soft drink, cordial and fruit juice, as they seem to increase the risk of stitches occurring during play. These type of drinks empty more slowly from the stomach than both water and sports drink, thereby leaving the stomach fuller for longer. It is also preferable for players to consume small amounts of fluid regularly during play, as this is better tolerated than large volumes of fluids being consumed at one time.

How should stitch be treated?

  • Stitches sometimes ease if you slow down and drop your exercise intensity for a short period.
  • The most common way to alleviate a stitch is to bend forward while pushing on the affected area and breathing deeply. Sometimes this can be done while playing but usually the pain eases more quickly when playing is ceased.
  • Another option is to lie down while elevating your legs.
  • The stitch is not usually a sign of a more serious problem. However, any pain that is persistant and does not ease when exercise ceases should be assessed by our physiotherapists or your GP.

Please note: this information should serve as a guide only. When in doubt always seek advice from Southside Physiotherapy & Sports Injury Centre or your GP.


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