From the Research
The exact cause of exercise-induced transient pain, commonly known as "stitches" or exercise-related transient abdominal pain (ETAP), remains incompletely understood, but the most widely accepted theory suggests that it results from irritation of the parietal peritoneum, which is the sensitive lining of the abdominal cavity, as supported by various studies 1, 2, 3, 4, 5. The irritation likely occurs due to repetitive movement during exercise that creates friction between the parietal peritoneum and organs, particularly when the stomach or other viscera are full. Other contributing factors may include:
- Diaphragmatic ischemia (reduced blood flow to the diaphragm during exertion)
- Stress on ligaments connecting abdominal organs to the diaphragm
- Spasms of the diaphragm due to insufficient oxygen
- Dehydration and electrolyte imbalances, which may affect muscle function, as seen in studies on exercise-induced pain and analgesia 2 The pain typically manifests as a sharp, stabbing sensation in the side of the abdomen, most commonly on the right side below the ribs, and is exacerbated by continued movement. While not dangerous, stitches can be prevented by:
- Avoiding large meals before exercise
- Maintaining proper hydration
- Gradually increasing exercise intensity
- Practicing proper breathing techniques during physical activity, which can help reduce the risk of diaphragmatic ischemia and other contributing factors 4. It's also worth noting that core-strengthening exercises, such as those described in the study on core-strengthening and intensive dynamic back exercises 4, may help improve core muscle endurance and reduce the risk of exercise-induced transient pain. However, more research is needed to fully understand the causes and prevention of ETAP, and to determine the most effective treatments for this condition, as the current evidence is limited and inconclusive 1, 3, 5.