From the Guidelines
To manage exercise-related transient abdominal pain, it is essential to prioritize proper hydration, gradual intensity building, and core strengthening exercises, as these measures can help reduce the likelihood of developing pain and improve overall athletic performance, as suggested by the most recent and highest quality study 1. When experiencing exercise-related transient abdominal pain, also known as a "stitch," the following steps can be taken:
- Slow down the activity and take deep breaths while bending forward slightly to relieve pressure
- Apply gentle pressure with fingers to the painful area while continuing to breathe deeply
- Ensure proper hydration by drinking fluids 1-2 hours before exercise, rather than immediately before, to reduce the likelihood of developing pain
- Gradually build exercise intensity to allow the body to adapt and prevent stitches from occurring
- Strengthen core muscles through regular exercises like planks and rotational movements to provide better support during activity
- Avoid eating large meals 2-3 hours before exercising, as a full stomach can contribute to abdominal discomfort It is also important to note that the use of non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of upper gastrointestinal complications and should be discouraged in athletes who experience persistent or recurring gastrointestinal symptoms, as reported in a study 1. Additionally, understanding the causes of gastrointestinal symptoms during exercise, such as reduced splanchnic perfusion and compromised gut permeability, can help athletes take preventive measures and make informed decisions about their nutrition and training, as discussed in a study 1.
From the Research
Characteristics of Exercise-Related Transient Abdominal Pain
- Exercise-related transient abdominal pain (ETAP) is a common condition affecting athletes, particularly those involved in activities with repetitive torso movement, such as running and horse riding 2, 3, 4.
- The pain is typically localized to the lateral aspects of the mid abdomen, along the costal border, and may be accompanied by shoulder tip pain 2, 4.
- ETAP can be described as sharp or stabbing when severe, and cramping, aching, or pulling when less intense 2, 3, 4.
Etiology and Prevention
- The exact etiology of ETAP remains unclear, with several theories proposed, including ischemia of the diaphragm, stress on the supportive visceral ligaments, gastrointestinal ischemia or distension, and irritation of the parietal peritoneum 2, 3, 4.
- Preventive measures include avoiding large volumes of food and beverages for at least 2 hours prior to exercise, improving posture, and supporting the abdominal organs through core strength or wearing a supportive broad belt 2.
- Strengthening the transversus abdominis muscle may also help reduce the incidence of ETAP, as it can increase intra-abdominal pressure and reduce excessive movement of the abdominal peritoneum 5.
Management and Relief
- Techniques for gaining relief from ETAP during an episode are largely anecdotal and may include slowing or stopping exercise, or using various methods without scientific validation 3.
- Slowing or stopping exercise can help alleviate ETAP, with the pain typically disappearing within minutes 3.
- Chiropractic care may also be beneficial for athletes suffering from ETAP, although further research is needed to fully understand its effects 6.