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Side stitch

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A side stitch (also called a side ache, a side cramp, a muscle stitch, or simply the 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).[1] Some people think that this abdominal pain may be caused by the internal organs (like the liver and stomach) pulling downwards on the diaphragm,[2] but that hypothesis is inconsistent with its frequent occurrence during swimming,[3] 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 does not require investigation.

Causes

The precise etiology of ETAP is unclear. Proposed mechanisms include diaphragmatic ischemia; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; or, most likely, irritation of the parietal peritoneum.[4][5]

Although the diaphragm is mostly innervated by the phrenic nerve, and thus could explain referred pain to the shoulder tip region, the main evidence against diaphragmatic ischemia is that ETAP can be induced by activities of low respiratory demand, such as horse, camel, and motorbike riding, where ischemia of the diaphragm is unlikely. In a study using a fluoroscopic technique, diaphragmatic movements during an ETAP episode have been shown to be full and unrestricted.[6] In another study, researchers analyzed flow-volume loops from subjects who were experiencing ETAP and found no compromise in any spirometry measures, suggesting that the diaphragm is not implicated directly in the etiology of ETAP.[7]

Frictional irritation of the parietal peritoneum has been suggested as a cause of ETAP.[8] The parietal peritoneum is the outer layer of the peritoneum that adheres to the abdominal wall and underside of the diaphragm. Because the portion of the peritoneum that underlies the diaphragm is innervated by the phrenic nerve, it could explain the shoulder tip pain.[9][10][11][12] The parietal peritoneum traverses the entire abdominal wall, which could account for the widespread distribution of ETAP; the tension in the parietal peritoneum is increased with torso extension; children have a proportionally larger peritoneal surface compared to adults, which could explain the increased prevalence of ETAP in younger individuals;[13][14] and pain arising from the parietal peritoneum relieves quickly on removal of the stimulus,[15] similar to what is observed for ETAP when activity is ceased.[16] In the postprandial state, distention of the stomach could increase friction between the visceral and parietal layers of peritoneum,[17] and consuming hypertonic beverages provoke ETAP regardless of increased gastric mass due to slowing of gastric emptying.[18] In fact, the fluid in the peritoneal cavity is highly responsive to osmotic gradients between it and its vascular supply.[19]

Occurrence

Side stitches occur in every level of athletes from school-aged children, weekend exercisers, or elite athletes, although they are more common in younger people. Approximately 66 percent of runners will experience at least one episode of a stitch each year. Activities that use upper body twists, like swimming, horseback riding, and running report this affliction more often.[20]

See also

References

  1. ^ Morton, DP; Callister, R (February 2000). "Characteristics and etiology of exercise-related transient abdominal pain". Medicine & Science in Sports & Exercise. 32 (2): 432–438. doi:10.1097/00005768-200002000-00026. PMID 10694128.
  2. ^ Collins, Andrew (2009). On Running on Lessons from 40 Years of Running. Bloomington, IN: Authorhouse. p. 148. ISBN 9781438936246. Retrieved 12 October 2015.
  3. ^ "965 athletes in six different sports (running, swimming, cycling, aerobics, basketball, and horse riding). Over the course of a year of training and competition, 75% of swimmers had trouble with stitches, 69% of runners were afflicted, 62% of horse riders had ETAP, 52% of aerobics participants suffered, 47% of basketball players did so, and 32% of cyclists were affected " Characteristics and Etiology of Exercise-Related Transient Abdominal Pain,' Medicine & Science in Sports & Exercise, Volume 32 (2), pp. 432-438, 2000
  4. ^ Morton, Darren P.; Callister, Robin (February 2000). "Characteristics and etiology of exercise-related transient abdominal pain". Medicine & Science in Sports & Exercise. 32 (2): 432–8. doi:10.1097/00005768-200002000-00026. PMID 10694128.
  5. ^ Morton, Darren; Callister, Robin (January 2015). "Exercise-Related Transient Abdominal Pain (ETAP)". Sports Medicine. 45 (1): 23–35. doi:10.1007/s40279-014-0245-z. PMID 25178498. S2CID 18088581.
  6. ^ Morton, Darren; Callister, Robin (January 2015). "Exercise-Related Transient Abdominal Pain (ETAP)". Sports Medicine. 45 (1): 23–35. doi:10.1007/s40279-014-0245-z. PMID 25178498. S2CID 18088581.
  7. ^ Morton, Darren P.; Callister, Robin (December 2006). "Spirometry Measurements During an Episode of Exercise-Related Transient Abdominal Pain". International Journal of Sports Physiology and Performance. 1 (4): 336–346. doi:10.1123/ijspp.1.4.336. PMID 19124891.
  8. ^ Morton, Darren P.; Callister, Robin (February 2000). "Characteristics and etiology of exercise-related transient abdominal pain". Medicine & Science in Sports & Exercise. 32 (2): 432–8. doi:10.1097/00005768-200002000-00026. PMID 10694128.
  9. ^ Capps, Joseph A.; Coleman, George H. (1 December 1922). "EXPERIMENTAL OBSERVATIONS ON THE LOCALIZATION OF THE PAIN SENSE IN THE PARIETAL AND DIAPHRAGMATIC PERITONEUM". Archives of Internal Medicine. 30 (6): 778–789. doi:10.1001/archinte.1922.00110120097004.
  10. ^ Dobbs, F. F.; Kumar, V.; Alexander, J. I.; Hull, M. G. R. (March 1987). "Pain after laparoscopy related to posture and ring versus clip sterilization". BJOG: An International Journal of Obstetrics and Gynaecology. 94 (3): 262–266. doi:10.1111/j.1471-0528.1987.tb02365.x. PMID 2952160. S2CID 29459513.
  11. ^ Jackson, S. A.; Laurence, A. S.; Hill, J. C. (May 1996). "Does post-laparoscopy pain relate to residual carbon dioxide?". Anaesthesia. 51 (5): 485–487. doi:10.1111/j.1365-2044.1996.tb07798.x. PMID 8694166. S2CID 35371138.
  12. ^ Narchi, P; Benhamou, D; Fernandez, H (December 1991). "Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy". The Lancet. 338 (8782–8783): 1569–1570. doi:10.1016/0140-6736(91)92384-E. PMID 1683981. S2CID 22742711.
  13. ^ Esperanca, Manuel J.; Collins, David L. (April 1966). "Peritoneal dialysis efficiency in relation to body weight". Journal of Pediatric Surgery. 1 (2): 162–169. doi:10.1016/0022-3468(66)90222-3.
  14. ^ Morton, Darren; Callister, Robin (January 2015). "Exercise-Related Transient Abdominal Pain (ETAP)". Sports Medicine. 45 (1): 23–35. doi:10.1007/s40279-014-0245-z. PMID 25178498. S2CID 18088581.
  15. ^ Capps, Joseph A. (1 December 1922). "Experimental Observations on the Localization of the Pain Sense in the Parietal and Diaphragmatic Peritoneum". Archives of Internal Medicine. 30 (6): 778. doi:10.1001/archinte.1922.00110120097004.
  16. ^ Morton, Darren P.; Callister, Robin (December 2006). "Spirometry Measurements During an Episode of Exercise-Related Transient Abdominal Pain". International Journal of Sports Physiology and Performance. 1 (4): 336–346. doi:10.1123/ijspp.1.4.336. PMID 19124891.
  17. ^ Morton, Darren P.; Callister, Robin (February 2000). "Characteristics and etiology of exercise-related transient abdominal pain". Medicine & Science in Sports & Exercise. 32 (2): 432–8. doi:10.1097/00005768-200002000-00026. PMID 10694128.
  18. ^ Morton, Darren Peter; Aragón-Vargas, Luis Fernando; Callister, Robin (April 2004). "Effect of Ingested Fluid Composition on Exercise-Related Transient Abdominal Pain". International Journal of Sport Nutrition and Exercise Metabolism. 14 (2): 197–208. doi:10.1123/ijsnem.14.2.197. PMID 15118193.
  19. ^ Morton, Darren; Callister, Robin (January 2015). "Exercise-Related Transient Abdominal Pain (ETAP)". Sports Medicine. 45 (1): 23–35. doi:10.1007/s40279-014-0245-z. PMID 25178498. S2CID 18088581.
  20. ^ Wetsman, Nicole (2017-10-20). "When you get a stitch in your side, what's really going on?". Popular Science. Archived from the original on 2017-11-13. Retrieved 2019-08-02.

Further reading

  • "The human spleen during physiological stress". Sports Medicine. 32 (6): 261–269. 2002. {{cite journal}}: Unknown parameter |authors= ignored (help)
  • "The effect of exercise on normal splenic volume measured with SPECT". Clinical Nuclear Medicine. 20 (10): 884–887. 2010. {{cite journal}}: Unknown parameter |authors= ignored (help)
  • "Spleen emptying and venous hematocrit in humans during exercise". Journal of Applied Physiology. 74: 1024–1026. 1993. {{cite journal}}: Unknown parameter |authors= ignored (help)
  • Mackenzie, Brian (1999). "Stitch". Sports Coach.
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