Exercise side stitch – how does it form? How to prevent a side cramp when running?

Man runner side cramps after running outdoors

Exercise stitch most often occurs during running and can thwart plans to finish the competition or break records not only for amateurs but also professional athletes. It attacks unexpectedly and you never know how intense it will be. Learn how the exercise side stitch is formed and how to prevent it.

Exercise-related transient abdominal pain (ETAP) is nothing but abdominal cramp, usually short-lived, appearing, as the name implies, during exercise, e.g. running, swimming. The pain caused by the cramp is prickly, sudden and sharp. According to a study conducted in 2009 among athletes, most of them felt the stitch on the right side of the abdomen – 58%, 43% of the testicular colic appeared on the left side and 21% – in the belly button. Interestingly, the thoracic spine in the abdominal region is sometimes accompanied by the pain on the upper side of the body, at the top of the shoulder. This happens in 15% of athletes.

At least 90% of amateur athletes and 61% of professional athletes experienced a side stitch at least once in their life, although most side cramps appears “only” at about 12% of activity. Such a frequency is sufficient to prevent the achievement of a sporting goal. Exercise side stitch thwarted plans e.g. for the world record holder in the marathon, Pauli Radcliffe, or Polish long distance runner Marcin Chabowski, who suffered from it during European Championship in 2014.

There was also a study on the occurrence of ETAP among 965 persons practicing various sports. It turned out that swimmers (75%) found themselves in the first place, and runners (68%) were in the second place. Next are people who are horseback riding (62%) and fitness class participants (52%).

Why swimming and running were at the forefront? It’s probably related to the anaerobic processes involved in both exercises, while the appearance of ETAP during horseback riding may occur because of the repeated vertical movements (the same is also true with running). The list lacks team sports: football, volleyball or basketball. Scientists explain that this is because, for example, during the game the riders do not move all the time at a steady pace and often have the opportunity to slow down.

How does a side stitch form?

Researches have been looking for the answers to questions about the causes of exercise side stitch for many years. However, it has not yet been possible to determine its causes. There are several, often mutually exclusive, hypotheses. The problem in determining how the cramp forms is due to the fact that it is difficult to investigate this phenomenon when the athlete is actively participating in a competition. It is never known whether and when the cramp will occur. Exercise stitches are therefore examined and discussed only on the basis of the descriptions of the persons in whom they occur.

Causes of ETAP

The most common causes of ETAP are:

  • Ischemia and contraction of the diaphragm, caused by blood flow to the peripheral muscles;
  • Irritation of the ligaments that attach it to the stomach, spleen and liver during the contraction of the diaphragm – these ailments are aggravated by deep breaths and repetitive vertical movements;
  • Due to the rubbing of the abdominal lining and the irritation of the diaphragm nerve, this nerve also runs in the neck area, so the appearance of the colic at the shoulder may be explained;
  • Thoracic problems – athletes with deep chest kyphosis (greater tenderness of the spine in this section) are more likely to experience colic;
  • Eating a rich meal shortly before the exercise;
  • Improper diet where fatty foods predominate;
  • Too short warm-up or lack of it;
  • Overestimating your sports opportunities – Too intense exercises on a particular stretch;
  • Electrolyte imbalance – dehydration;
  • Taking medication and getting started during illness;
  • High stress before competition or training.
Posted on: August 10, 2017

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