What is a Stitch Any Way?


You’re going to do it this time. You usually hate cardio, but dammit, you’re going to get better at running so you don’t hold everyone back when you eventually cave in and do a Tough Mudder.
You lace up your Vibrams, stretch off and you’re away, but before you even get to the end of the street you feel it set in. Your side starts cramping; it’s as if something is pulling at the inside of your torso.
You’ve got a stitch, and it sucks. What the hell is it?

This is actually not all that well researched. Despite the fact that around 70% of runners experience it in any given year and around 20% of athletes will get it in any given competition, we aren’t 100% sure what the cause is.
A lot of old theories have been debunked, however. Ischemia of the diaphragm (inadequate blood supply) has been ruled out because stitch can be instigated by low intensity activities like motorbike and camel (you read that right) riding.
Mechanical stress on the ligaments within your abdomen from your organs ‘bouncing’ was my personal guess but again, no. Some stitches are really low in the abdomen which wouldn’t make sense, and stitch is also highly common in swimmers who don’t jolt around very much.
Finally, the ligaments in question attach to the skin within the abdomen and pulling on them would therefore be non-localised but as anyone prone to stitch can tell you, localisation is pretty much a given.
The next theory is GI disturbance due to eating too close to exercise. This is one of the most commonly cited causes but even this has issues. Gi pain is usually relieved a little by writhing around, but a stitch is helped by cessation of movement. Furthermore, stitches are still experienced by those training fasted.
Muscle cramps? Nope. People with stitches don’t show a higher localised amount of EMG activity (electromyographic – a machine which can tell how much a muscle is being innervated), but people with cramps do.
The most well-supported theory is irritation of the Parietal Peritoneum, which is the outer layer of the peritoneum, the inner lining of your abdominal cavity. Friction between the visceral and parietal layers may cause pain, which is made worse by stomach distention in the post-prandial state. This would explain why stitches are worse during activity which requires some kind of rotation like running or swimming.
Much more is left to find, though, and we must bare in mind that it may be a combination of things!
But enough of that – how do you deal with it?!
Well, researchers note that those prone to stitch have a thinner transverse abdominis than those who are asymptomatic. The TVA is the sheet of muscle lying below the rectus abdominis (the 6 pack muscles), and it’s really effectively trained by performing heavy full body compound movements like squats and deadlifts.
Of course, reducing meal size pre workout or increasing time between your last pre workout meal and your session may be beneficial, and hypertonic drinks seem to exacerbate issues, so they are best avoided if possible.
Improved posture seems to help. Running coaches are a really good investment, though they are often forgotten about, and if you’re REALLY susceptible, a supportive belt could have a great deal of efficacy.
Finally, when it does strike, deep breathing, pressing the site and telling your running partner how much you hate running will probably make you feel better.
1 – Darren Morton and Robin Callister. “Exercise-Related Transient Abdominal Pain (ETAP)”. Published online 2014 Sep 3. doi:  10.1007/s40279-014-0245-z
– Tom


(Permission to share given by BTN)