Side stitch

Overview
When exercising, a side stitch (or side cramp) is an intense stabbing pain under the lower edge of the ribcage. It is also referred to as exercise related transient abdominal pain (ETAP). This pain is caused by the internal organs (like the liver and stomach) pulling downwards on the diaphragm. It is therefore more likely to occur in sports involving up and down actions - like running, jumping and horse riding.

There are more theories regarding ETAP than merely stretching of the visceral ligaments due to repeated vertical translation and jolting. Other theories include:


 * 1) Diaphragmatic Ischemia
 * 2) Imbalances of the thoracic spine
 * 3) Irritation of the parietal peritoneum

The reasons for these 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 is due to the largest organ in the abdominal cavity, the liver, being 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.

Preventing a side stitch

 * Improve fitness
 * Strengthen the diaphragm by using exercises such as those that aid respiratory rehabilitation
 * Strengthen core muscles (abdominals, lower back, obliques)
 * Limit consumption of food and drink two to three hours before exercising (in particular, drinks of high carbohydrate content and osmolality (reconstituted fruit juices))
 * Drink water beforehand to prevent muscle cramps
 * Warm up properly
 * Gradually increase exercise intensity
 * When running
 * Exhale when the left foot hits the ground, and inhale when the right foot hits the ground
 * Run on soft surfaces

Curing a side stitch
Possible treatments for side stitches include:
 * Stop exercising. With your fingers, push into your abdomen on the right side, and up under the rib cage. At the same time, forcefully let out a deep exhale while holding your lips closely together.
 * Stop exercising until the pain goes away.
 * Try belly breathing; Inhale while pushing out your abdomen, and on the exhale, relax your abdominal muscles.
 * Stop exercising and touch your toes with your fingers, moving your liver away from your diaphragm.
 * Breathe on different steps
 * Reduce the frequency of breathing (e.g. in jogging, inhale for four steps and exhale for four steps)
 * Lie down on your back and lift the knee on the side with the stitch up to your chest.