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SIDE STITCH
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What is it?

Exercise-Related Transient Abdominal Pain (ETAP) is more commonly known as a side or runners “stitch.” This pain is considered harmless, but can affect athletic performance in many individuals. The side stitch is more common in younger athletes (rarely before the age of 10) and in those who participate in sports which involve repetitive jarring, shaking or twisting of the abdomen, such as running and horseback riding.

Some people report side stitches after eating or drinking. Interestingly, the side stitch is not related to the intensity of exercise. Also, it does occur in elite athletes but is more common in recreational athletes.

 

Symptoms/Risks

Symptoms of side stitch may include:

• Mild pain that starts as a cramping, aching or pulling sensation which can feel sharp or stabbing when severe

• Localized side pain of the lower ribcage or mid-abdomen (right side is more common than left)

 

Sports Medicine Evaluation & Treatment

If you are experiencing ETAP that is preventing your participation in sports or limiting your performance, you should discuss your symptoms with a sports medicine physician. It is important to rule out other rare causes of abdominal pain that can occur with exertion, such as muscle strain of the chest or abdomen, stress fracture of the rib, reduced blood supply to the bowel, adhesions in the gut, or chronic constipation.

The physician will ask you multiple questions regarding the location and onset of pain and will examine your chest, back and abdomen. Diagnosis can usually be made with the history and physical exam. Blood work and imaging (x-rays, ultrasound, etc.) are seldom required.

Treatment of ETAP usually involves:

• Have a coach analyze your technique for mechanical errors

• Have an expert fit your equipment/gear

• Consider a strength and conditioning coach specific to your sport

- Identify training errors

- Create a sport specific core strength and flexibility plan

• Manual therapy of the spine (physical therapy, osteopathic manipulation)

• Review your nutrition practices

 

Injury Prevention

Some suggest the following to avoid getting side stitches:

• Keeping the core (abdomen and back) muscles flexible and strong

• Maintain good posture

• Eat/drink familiar things in small quantities on a regular basis (train your gut)

 

Return to Play

Common techniques reported to help stop symptoms once they have started include:

• Deep breathing

• Pushing on the affected area

• Bending over and forward

• Stop exercise and rest

AMSSM Member Authors
Crystal Hnatko, DO and Courtney Dawley, DO

References
Morton D, Callister, R. Review: Exercise-Related Transient Abdominal Pain (ETAP)

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