Physiotherapy | Physiotherapist Clinic Singapore - Dealing with side stitches
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Side stitches, plural for a side stitch, is also known as side cramps, side aches or stitches) and it's characterized by very acute and intense stab-like pain under the lower part of our rib cage that happens when we exercise.
It's also been referred as ETAP, which is exercise related transient abdominal pain. A common favorite theory about why it happens is because our internal organs such as the liver and stomach pulls downward on the diaphragm, or the diaphragm "knocking" the soft tissues causing pain because of poor stepping mechanics as one runs.There's been quite a number of articles that suggests symptoms can be reduced by adjusting at what point your stride or step is as you inhale to prevent the "knocking".
Thing is, side stitches also frequently happens to swimmers or people who swims, and here is where the original theory falls flat - there is not "knocking" or diaphragm with the stomach or liver because there is no stepping or vertical forces, yet the pain due to stitches is there. If the pain is there only when exercising and no pain is present during rest/non-exercise, then one can conclude there should not be any problems.
There are four common theories regarding the causes of this condition:
- Stretching of the visceral ligaments due to repeated vertical translation and jolting (as mentioned above)
- Autotransfusion, the contracting of the soft tissues such as liver or spleen, which can work extra hard when necessary to squeeze extra oxygen-rich red blood cells into circulation. This increases exercise capacity but is often associated with severe and sharp pain, which is relieved only by rest. A possible mechanism for pain is that because of high pressure in the liver or spleen may restrict blood flow, causing hypoxia (decreased oxygen supply)
- Ischemia of the diaphragm
- Imbalances within/of the thoracic spine
- Peritoneal parietal irritation
Why so many varieties is because of the prevalence of side stitches during swimming. Interestingly, these stabbing pain often affects the right side of the body as compared to the left - possibly because the largest organ in the abdominal cavity, which is our liver, is on our right side of our body.
Some athletes have also reported pain at the very tip of their shoulder blade (at the bottom most point of the scapula). This is often caused by referred pain through the phrenic nerve for the diaphragm. Often, when the side stitch is on the right side, most published advice is to try and exhale when your left foot/stride strikes the ground.
How To Prevent
- Stay Hydrated - drink frequently in small sips before and during exercises. Dehydration is a relatively common cause of side stitches (increases muscle contractility)
- Increase Condition and fitness levels by following an exercise regime
- Strengthen Your Lungs - strengthen your diaphragm by using exercises such as those used for chest physiotherapy. One of the exercises is to prolong your exhalation for as long as possible, about 10 times per day. Aim to hit 10-15 seconds of exhalation.
- Strengthen Your Core (abdominals, lower back, obliques)
- Don't consume or at least limit your food and drink two to three hours before exercising (especially high sugar/carbohydrate content)
- Warm Up Well - take five to ten minutes to increase your heart rate and get your blood pumping throughout your body before starting your exercises and activities
- Build Intensity Gradually - start slow then gradually build up speed and intensity
- Run On Soft Ground
- Breath Deep
- Slow The Pace - of all activities and exercises, until you're fully warmed up and well versed
Where to next?
- Make An Physiotherapy or Hand Therapy Appointment
- Arrange A CallBack or Make An E-Enquiry Here
- See the list of physiotherapy conditions we treat
- Return to Urbanrehab's Physiotherapy and Hand Therapy Singapore Home Page from our Side Stitches Page
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We are a wholly Singapore Private Limited group of licensed physiotherapists, hand therapists, podiatrists, chiropractors, sports massage therapists, clinical pilates practitioners and TCM physicians practicing in our scope of rehabilitation and its areas of specializations. As listed in our website are the list of services we provide our clients as referred by their medical doctors or by self referrals/word of mouth.
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