A "stitch" is a common abdominal pain usually associated with running sports. It is brought about by various physiological factors. Among the more common causes are muscle spasm of the diaphragm or eating too much and too soon prior to exercise. The muscle spasms of the diaphragm usually arise because not enough oxygen is getting to the muscle. This can be due to poor conditioning, improper breathing techniques, and/or ischemia of the diaphragm. Other factors include; constipation, intestinal gas, distended spleen, or weak abdominal muscles.

Signs and Symptoms

• Sharp pain on either side usually just below the rib cage.
• May be more severe when breathing in sharply.

On-Site Management

Attempt to Relax Spasm. Have the athlete try changing her/his running stride length or decreasing the pace.

Attempt to Regulate Breathing. Diaphragmatic breathing (pushing the stomach out on deep inspiration and pulling it in on expiration) will often ease the "stitch".

Compression. Apply compression over the area with a hand.

Stop Activity. If the above methods fail to relieve the pain, stop activity and raise the arm of the affected side over the head and stretch. Another commonly used method is to flex the trunk forward.

Referral. If a stitch constantly reoccurs, medical attention should be sought, there may be a more serious problem involved.

Return to Activity

The athlete can continue activity after the pain has gone away or has been reduced significantly. If the pain reoccurs the athlete may have to stop activity at that point.

Prevention

There is no real way of stopping a stitch or abdominal cramp from occurring, but education on proper breathing techniques, meal timing, and/or proper training techniques can reduce the risk of occurrence.

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