With the warmer weather here, we often become more active and we come out of shells to begin a exercise regime. that puts beginner exercisers off is having a stitch.
Over the year we have not really known what causes stitches, but they can become quite uncomfortable and, in more sever cases, stop individuals exercising altogether.
It’s the pain in the torso that can dash athletes’ hopes of winning races and turn some of us mere mortals off exercise altogether. But what causes a stitch and what can you do about it?
A stitch is a pain in the abdomen (usually on the side) that’s brought on by activity and it’s the bane of many runners’ lives. It can range from sharp or stabbing to mild cramping, aching or pulling, and may involve pain in the shoulder tip too. And it often leaves you with no choice but to slow down or stop.
It can dash hopes of winning races and put couch potatoes off donning running shoes in the first place.
But stitches also afflict swimmers, horse-riders and even motor-cyclists, says Dr Darren Morton, an Australian scientist who is somewhat of a world authority on the phenomenon.
Morton, a senior Lecturer in the Faculty of Education and Science at Avondale College of Higher Education in NSW, himself suffered stitches quite badly in his earlier athletic career as an ironman, triathlon and surf lifesaver.
“I consulted fairly broadly and no-one seemed to have much an idea what caused them so it just seemed like a perfect topic to explore further,” he says.
He’s now “99 per cent sure” that what’s really behind a stitch is an irritation of the membrane lining the abdominal cavity and that what (and when) you eat and drink before you get active can raise or lower the odds of having one.
Tips to avoid a stitch
So what are some top tips to reduce the odds of a stitch next time you get active?
There’s most evidence for these three:
- Make sure you’re well hydrated by drinking lots of water in the 12 hours before you exercise. In the two hours immediately before, drink only small amounts so you stay hydrated, but your stomach’s not bloated (and therefore less likely to press on the lining of your abdominal cavity).
- Don’t eat large volumes of food for at least two hours before exercise (perhaps even three to four hours before if you’re especially prone to stitches).
- Avoid very sugary drinks, such as fruit juice or soft drinks, before or during your exercise. Sugary foods like lollies may also be a problem.
There’s less evidence for these, but they’re still worth a try:
- Get fitter: Some evidence suggests the fitter you are, the less frequently you get stitches. Exactly why isn’t understood. But plenty of very fit athletes are still plagued by them.
- Strengthen your core: Strong trunk muscles, especially the deeper abdominal muscles, the transverse abdominus, may help ward stitches off, probably by offering more support to abdominal organs. Pilates and exercises using a stability ball may help.
- Improve your posture: “We haven’t yet done intervention studies to see if changing people’s posture makes a difference but we have anecdotal reports of people who’ve done that and it’s been helpful.” A physiotherapist may be able to help.
If you do get a stitch, you might find the following techniques can bring relief:
- deep breathing
- pushing or stretching the affected area
- bending over forward.
In lab experiments, stitches generally disappeared 45 seconds to two minutes after stopping activity. Some people can still feel sore a couple of days later though.
A fraction too much friction
The membrane lining the abdominal cavity is known as the peritoneum. It is a double-layered membrane, with the outer layer lying tight against the front abdominal wall and folding around under the diaphragm, the dome-shaped sheet of muscle that separates your chest from your abdomen. The inner layer of the membrane wraps around the contours of the abdominal organs. Between the two layers is a small amount of fluid, which helps reduce friction when your organs shift as your body moves.
Morton’s theory is that this protective system sometimes goes wrong, and there is friction between the layers, resulting in irritation and the pain we call a stitch. The lining under the diaphragm is attached to the phrenic nerve, which refers pain to the shoulder tip region, which may explain why some people get shoulder tip pain with a stitch.
The link with sugary drinks
The irritation can be triggered by pressure from the inside when organs, such as your stomach, are very full and swollen.
But it can also happen when the amount of fluid in the space between the two layers drops. One thing we know can cause this is drinking concentrated fluids such as sugary drinks.
“What we know is that things like really sugary drinks draw fluid out of that space and are very provocative of stitches,” Morton says.
In experiments where people are given such drinks, like fruit juice or soft drink, and then asked to exercise “everyone sort of keels over left, right and centre with a stitch”, he explains.
Sports drinks, which are around 6 per cent sugar (compared to around 11 per cent for fruit juice), don’t have this effect. In fact, they are no worse than water at bringing on a stitch.
Sugary drinks have a “double whammy” effect – reducing the rate at which the stomach empties its contents into the intestines, which may lead to bloating and further friction through direct pressure.
While high fat foods also slow the emptying of the stomach, and hence help to bring on stitches, they’re less frequently eaten before exercise than high sugar food and drinks.
Mentions of stitches date back to the first century, when Pliny the Elder recommended treating them with “the urine of a she-goat, injected into the ears”. In Shakespeare’s “The Tempest”, Prospero said “tonight thou shalt have… side-stitches that shall pen thy breath up.”
Stitches are more common in activities involving vigorous upright repetitive movement of the torso but can occur in any type of sporting activity. They strike one in five in a typical distance race like Sydney’s City to Surf.
77 per cent of active individuals under 20 years experience stitches, but only 40 per cent over 40. They are rare before age 10.
Right side pain is twice as common as left side but no-one knows why.
Still a widespread problem
“We’ve got no evidence of anyone dying from stitches, so in that regard, they’re relatively benign,” Morton says. But they’re still a widespread problem.
“Over the years I’ve had hundreds of emails from people saying ‘please help me, I’ve got some big event [coming up]’. And I know plenty of people who say ‘I don’t want to go for a run because I always get a stitch’. So what are stitches doing from a public health perspective?”
The stitches that plagued Morton in his youth are no longer an issue. This fits with the general finding that people tend to grow out of stitches “probably because the nature of our tissues changes as we age,” he says.
“I very seldom get stitches now and I used to get really debilitated by them. I used to get them just walking around. It probably just indicates I’m growing old… or I’m not running fast enough.”
Old stitch theories discarded
Early theories suggested stitches were caused by a lack of oxygen to the diaphragm, or by the jiggling of ligaments connecting abdominal organs to it.
But Morton says it’s become fairly clear these ideas are wrong. Both the diaphragm and limbs work harder during exercise, so a drop in oxygen to the diaphragm is unlikely. Other laboratory studies also don’t support the idea.
What’s more “in World War 2, when the torpedo boats were going across the [English] Channel and it got rough, the guys would get bad stitches just standing there [without doing any activity]. So it doesn’t make sense it’s an insufficient blood flow problem.
“And we now know stitches are also very common in swimmers, where people are lying down and there’s not a lot of stress on those [abdominal] ligaments,” Morton adds. “And the pain characteristics aren’t consistent with what we know about what it feels like when these ligaments get stretched anyway. We also know people get stitches right down low in their abdomen sometimes, which is nowhere near these ligaments.”
It’s the longitudinal rotation of the trunk in swimming rather than the torso moving up and down that plays a role when swimmers get stitches, he says.
Research has shown stitches are 10.5 times more common in running than cycling though. He thinks the bent forward position cyclists adopt may take some tension off the abdominal lining.
So there you have it. I hope this information was beneficial to you and you can go forth and exercise with confidence.