We’ve all likely experienced that pain in our abdomen when exercising, known as a ‘stitch’. But what exactly are stitches, and can we do anything to get rid of them?
Introduction
I was out for a run the other night, and I felt something that I haven’t felt in probably 13–14 years. Naturally, it took me a little while to realise that this weird pain at the top of my abdomen was a stitch. Once I realised what it was, I began to breathe deeply into my diaphragm, while also forcing out some burps (gross, I know). The pain mostly subsided after a few minutes, and I was left thinking about whether the deep breathing worked, or if the burping was the reason the stitch left. Or, maybe the stitch spontaneously left as quick as it spontaneously arrived?
Once the discomfort fully subsided, I decided that I was not happy with the fact that I hadn’t a clue why the stitch disappeared. Naturally, my next thought was to look into this topic more thoroughly for this week’s article. Well, I did, and in the following paragraphs I will lay out: 1) what a stitch is; 2) how common they are; and 3) strategies to prevent and manage them.
Image source: Runner’s World
What is a ‘Stitch’?
In scientific terms, a stitch is known as exercise-related transient abdominal pain, or ETAP (1). There are a number of possible causes of ETAP (1), including:
Lack of oxygen to the diaphragm
Mechanical stress on visceral ligaments surrounding the abdomen and diaphragm
Gastrointestinal disturbances
Muscular cramp
Neurogenic pain (i.e., pain arising from damage/dysfunction to the nervous system)
Irritation of the parietal peritoneum (i.e., the membrane that lines the abdominal cavity)
Because of the consistent characteristics of ETAP reported in a range of different individuals and sports, it is thought that a singular cause is likely (1). However, while some of the above theories are plausible causes, the cause of ETAP is still speculative and yet to be determined.
How Common is ETAP?
In a study of almost 1,000 individuals involved in six sporting activities (i.e., running, swimming, cycling, aerobics, basketball, horse riding), the reported prevalence of ETAP in the past year ranged from 32% in cyclists to 75% in swimmers (2). In terms of location, ETAP was reported more often in the right and left lumbar regions (i.e., the sides of the abdomen), although ETAP was reported to occur in all regions of the abdomen (Figure 1) (2). In terms of the type of pain experienced, individuals often reported the pain to be well-localised (i.e., specific to a region) as well as sharp in nature, and there were no significant differences in the reported sensation, severity, or localisation of ETAP between individuals of different sports (2).
Figure 1. The prevalence of individuals reporting ETAP across different regions of the abdomen (2).
In a separate study, 68% of triathletes reported experiencing ETAP while running, but only 15% reported experiencing ETAP while swimming, and 8% while cycling (3). The lower prevalence compared to the previous study may be related to age, as the individuals in the previous study were younger than those surveyed in this study, and younger age is known to be associated with ETAP (1). Other research suggests that approximately one in five participants will experience ETAP during a running event (1).
How Can ETAP be Managed?
Because the cause of ETAP is not fully understood, there is a lack of robust scientific evidence underpinning approaches to prevent and manage ETAP. With that said, there are some approaches that may be useful (1):
To prevent ETAP, it is recommended to avoid large volumes of food and drink in the two hours prior to exercising. If you are particularly susceptible to ETAP, this advice may extend to three to four hours prior.
Engaging in exercises to improve torso stability (e.g., plank, deadbugs) may be helpful for preventing ETAP.
Wearing a wide, supportive belt during exercise may also help to prevent ETAP.
Deep breathing has been reported as a common technique to alleviate ETAP by sufferers, as well as pushing on the affected area, stretching the affected site, and bending over forward. However, the effectiveness of these approaches has not been rigorously determined.
The most effective strategy for alleviating ETAP is to stop exercise; however, this is rarely practical or desirable.
Did you read last week’s blog? If not, you can check it out here.
Summary
Unfortunately, the evidence underpinning approaches to dealing with stitches is quite underwhelming. Despite this, there are a number of strategies that can be implemented to try to prevent and manage ETAP. If you are a frequent ETAP sufferer, my advice would be to log your symptoms before and after implementing these strategies (one by one), to see if you can spot any patterns that emerge. This way, you can get a better understanding of which strategies to prevent and manage ETAP may be working for you (or not).
If you are interested in levelling up your football skills, contact us at [email protected] to book in with our expert coaches for a session. And remember to sign up to our mailing list (if you haven’t already!) to be notified when a new blog article drops. Don’t worry, we do not spam!
Thanks so much for reading, and have a lovely weekend!
Patrick Elliott, BSc, MPH
Health and Nutrition Science Communication Officer at Training121
Instagram: @just.health.info
Twitter/X: @PatrickElliott0
References
(1) Morton D, Callister R. Exercise-related transient abdominal pain (ETAP). Sports Med. 2015;45(1):23–35. Available at: https://link.springer.com/article/10.1007/s40279-014-0245-z
(2) Morton DP, Callister R. Characteristics and etiology of exercise-related transient abdominal pain. Med Sci Sports Exerc. 2000;32(2):432–8. Available at: https://journals.lww.com/acsm-msse/fulltext/2000/02000/characteristics_and_etiology_of_exercise_related.26.aspx
(3) Sullivan SN. Exercise-Associated Symptoms in Triathletes. Physician Sportsmed. 1987;15(9):105–8. Available at: https://www.tandfonline.com/doi/abs/10.1080/00913847.1987.11702083
Technical Terms
Diaphragm: A large, thin muscle that sits underneath your lungs and separates your chest from your abdomen. When you breathe in, it contracts and moves downward, making space for your lungs to expand and fill with air. This helps you breathe in oxygen. When you breathe out, the diaphragm relaxes and moves back up, helping to push air out of your lungs.
Membrane: A thin, flexible barrier or covering that can be found in different parts of your body. It's kind of like a very thin skin. Membranes can have different jobs depending on where they are. For example, some membranes help protect organs or keep them in place, while others help control what goes in and out of cells. They can be found all over your body, like the lining of your mouth, the covering of your brain, or even inside your cells.