Side Stitch

Original Editor - Ayushi Tomer

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Introduction[edit | edit source]

Side stitch is an acute, localized, pain on the upper side of the abdomen which can occur after exercise.

It is also called Exercise Induced Abdominal Pain (E.I.A.P.). [1]

The site of pain is depicted in red color.

Causes[edit | edit source]

  • High Intensity exercise
  • Low level of fitness
  • Running[2]
  • Stress on Diaphragmatic ligaments
  • Rib fracture (10th/ 11th/12th)
  • Most common causes are diaphragmatic ischemia and spasm.[1]

Signs And Symptoms[edit | edit source]

  • Post-exercise pain on the upper right quadrant of abdomen. The pain is mostly laterally oriented.
  • Pain stops after the cessation of exercise.
  • Pain is sharp/stabbing in severe cases.[1]
  • This pain is more consistent and can also present in activities that are not in high respiratory demand.

Physiology[edit | edit source]


The increased level of respiratory muscle work along with an increased competition for blood flow with limb locomotor muscles causes more burden on the diaphragm. Diaphragm gets fatigued which causes an increased sympathetic vasoconstrictor outflow to the skeletal muscles of the body, which reduces limb blood flow and increases the intensity of exercise-induced locomotor muscle fatigue. This mechanism reduces the exhaustion time of the person, and the activity intensity has to be reduced or ceased to limit the extent of fatigue.[3]

Physiotherapy management[edit | edit source]

  • Proper warm-up and cool-down
  • Core- strengthening
  • Slow down – try to change your foot strike and breathing to match one another. For example, if the stitch is on the right, exhale when the left foot hits the ground and vice versa
  • Pursed lip breathing
  • Tighten your abdominal muscles as if you were bracing for impact.
  • Try to avoid consuming large meals or drinking in excess before exercises.[4]
  • When participating in a long run or high endurance workouts, drink small sips of water throughout to keep yourself hydrated.
  • Practice Abdominal breathing.

Evidence Based[edit | edit source]

Increased vertical displacement of the body and reduced angle of the neck, trunk and hips may be important factors affecting the incidence of stitch. Therefore, by modifying these factors in people with stitch, would reduce the incidence of a stitch.[5]

References[edit | edit source]

  1. 1.0 1.1 1.2 Eichner ER. Stitch in the side: causes, workup, and solutions. Current sports medicine reports. 2006 Nov 1;5(6):289-92.
  2. Morton DP, Aune T. Runner’s stitch and the thoracic spine. British journal of sports medicine. 2004 Apr 1;38(2):240-.
  3. Romer LM, Polkey MI. Exercise-induced respiratory muscle fatigue: implications for performance. Journal of Applied Physiology. 2008 Mar;104(3):879-88.
  4. Plunkett B, Hopkins W. Investigation of the side pain" stitch" induced by running after fluid ingestion. Medicine & Science in Sports & Exercise. 1999 Aug;31(8):1169-75.
  5. Safari BM, Khoshraftar yn, Hakak de. Comparison of vertical displacement of the body and body angles during running in the people with side stitch and healthy people.