I had a pretty bad experience during a half marathon last weekend which brought about this post. Around 7km in, I developed a ‘stitch’, a sharp stabbing pain up under my ribs. No matter what I did, I couldn’t get rid of it, struggling through the last 14km without being able to push myself in any way. I probably dropped 15 minutes off the time I was expecting. Incredibly frustrating experience…

Well, I’ve decided to do some research, both for my own sake (to prevent future incidents) and hopefully to help others avoid the painful ailment.

Here is what I’ve found..

What is a Stitch?

“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)”

“The pain usually eases within a few minutes after exercise has stopped, however some people experience some residual soreness for a few days, especially after severe pain. The Stitch seems to be more prevalent in activities that involve vigorous upright, repetitive movement of the torso.”

What Causes it?

“Scientists are unsure of the exact cause of stitch.” Look’s like we’re off to a good start here..

“For some time, stitch was thought to be caused by a reduction in blood supply to the diaphragm, a large muscle involved in breathing. It was thought that during exercise, blood was shunted away from the diaphragm and redirected to exercising muscles in the limbs. This theory has now lost favour with scientists. Both the diaphragm and the limb muscles have to work harder during exercise so it is unlikely that an inadequate blood flow would be directed to them.

Another popular theory is that stitch is caused by organs pulling on the ligaments that connect the gut to the diaphragm. Ligaments that support organs such as the stomach, spleen and liver are also attached to the diaphragm. Jolting during exercise may cause these organs to pull on the ligaments and create stress on the diaphragm.

A more recent idea is that stitch is caused by irritation of the parietal peritoneum. Two layers of membrane (peritoneum) line the inside wall of the abdominal cavity. One layer covers the abdominal organs. 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.

The parietal peritoneum is attached to a number of nerves. It is thought that the stitch occurs when there is friction between the abdominal contents and the parietal peritoneum. This friction may be caused by a distended (full) stomach or a reduction in the lubricating fluid.” Source: ausport.gov.au

That’s the scientific version..

What is essentially being said, is that a stitch is predominantly caused by either solids or fluids that are being digested at the time of intense exercise.

Due to the ‘pulling’ or ‘tugging’ motion described above, high intensity exercise, without an adequate warmup, may also be a factor.

In my own case, I ate a meal of fatty tuna and brown rice about an hour before I started running. Besides some light stretching, I also failed to warm-up properly.

How to Prevent it..

The consensus seems to be a combination of the following..

Drink plenty of low-GI fluid in the 24 hours leading up to the event.

Don’t eat large meals within 2 hours of intense exercise. (Particularly avoid fatty, harder to digest foods)

Avoid extremely sugary foods and drinks like fruit juices and soft drinks.

When consuming fluids during activity, drink smaller amounts at regular intervals.

Warm-up sufficiently before intense exercise.

Regulate your breathing- Slow, deep and controlled breaths provide more efficient blood-flow that short, gaspy breaths.

If you get a stitch anyway..

The common treatments seem to be

Stop, bend forward and touch your toes

Place pressure on the affected area with your hand/fingers.

According to Runnersworld, this is the solution:

“If you still get another side stitch, implement this strategy and it will go away in seconds (I promise). Slow your pace and exhale as the foot on the opposite side of the stitch strikes the ground. This doesn’t mean every time that foot hits the ground, but as you exhale, do so in sync with that opposite side. When you exhale, you use the muscles of your diaphragm. When this happens in unison with your foot striking the ground, the impact forces travel up the body and through your core (your side too) and exacerbate (piss off) the muscles in spasm creating that stitch. When you change the side of the landing forces to the opposite side, the tension causing the stitch releases. For example, your stitch is in your right side. You slow your pace, and exhale as your left foot is hitting the ground. Voila! Side stitch is history and you’re running without swearing once again.”

I didn’t stop for a good 2-3km after I got mine in the half-marathon, pushing through until I got to the next drink station. Very unwise move.. Next time I will be stopping immediately to deal with the problem.

There you have it. Hopefully that helps you out and you will forever be rid of the little painful bastard known as a ‘Stitch’.