How do I know if I have stitch?
Typically, stitch is felt in the right upper abdomen, but may also occur on the left hand side, or may irradiate to upper or lower regions of the body. "Classic" stitch is more likely to occur to insufficiently trained people than well prepared athletes.
What causes Stitch?
The reason for stitch is simple. The inner organs are hanging from several ligaments, which, in turn, are fixed to the diaphragm, the muscular "plate" between chest and abdomen. Liver, spleen, stomach, small intestine and colon form a weight of several kilograms, hanging from the diaphragm. The impact of every step forces the inner organs to move downwards. Additionally, the diaphragm moves upwards on every expiration to force air out of the lungs. This continuous up/down stress may cause a cramp in the diaphragm: stitch. Stitch occurs most often on the right hand side because of the liver being the heaviest organ, and therefore the one stressing the diaphragm the most.
In his research Sinclair (1951) concludes that several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; 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; and irritation of the parietal peritoneum. Of these theories, irritation of the parietal peritoneum best explains the features of Exercise-related transient abdominal pain, however, further investigations are required
Shoulder tip pain
The diaphragm is supplied by branches of the phrenic nerve that originates in the neck. This may explain the common association of stitch with shoulder tip pain.
How do I get rid of Stitch?
Should you suffer from stitch, the first (and best) cure is to slow down or stop until the stitch is gone. If you do not want to stop, you can try to press your hand onto the part of your abdomen where the stitch is, and release the pressure on expiration. Repeat this several times.
Tim Quinlivan, a PE Teacher in Australia, has found the following method works well with his young athletes:
An alternative method based on the theory it is caused by the synchronisation of the movement of the organs and the diaphragm is to synchronise your breathing pattern with your running, and exhale/inhale when the foot on the non hurting side strikes the ground.
For example: if you have stitch in your right hand side, change your breathing pattern so you exhale/inhale as your left foot strikes the ground.
How can I avoid Stitch?
Strengthen your abdominal muscles (core stability), keep your upper body warm, do not run too soon after meals and learn "abdominal breathing".
The following references provide additional information on this topic:
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The following Sports Coach pages should be read in conjunction with this page: