It’s the summertime and I’m sure everyone is out hiking, running or climbing their way to new fitness levels right? Even if you’re not, I’m sure everyone has either experienced, or watched someone else experience, the dreaded “side stitch” that has crippled many an athlete or fitness enthusiast while exercising. It usually occurs in actions that involve repetitive rotation or hyper-extension of the torso, such as running or swimming. It manifests as an aching sensation in the side of the torso that usually forces the individual to stop in their tracks, flex the spine, tighten the abdominals, breathe through tightened lips and vigorously massage the affected area. These are in fact the best ways to alleviate the pain. But what causes this phenomenon and how do we prevent it?

I’m glad you asked. There is nothing more frustrating than getting in the zone for an intense cardiovascular challenge only to be plagued by this condition. When I started doing the Grouse Grind again this year I found myself disabled at the 1/2 mark but I wasn’t even out of breath. I noticed it was happening at the same time and on a regular basis. This encouraged me to look into this matter a little more deeply and here’s what I uncovered.

If you ask people what causes side stitching, most will respond that it’s a buildup of  lactic acid or waste product in the muscle. This completely unfounded. Why does lactic acid get blamed for everything? It even gets blamed for sore muscles. All untrue. Medical experts recognize this condition as ETAP or exercise-related transient abdominal pain , and have several theories as to its cause.

What Causes Side Stitches

The first theory suggests that the pain begins as the flow of blood to the respiratory organs is compromised as it is diverted to the working muscles or to aid in digestion. So what your mother always told you was sound advice. Don’t go swimming or playing right after dinner. I’m sure my mother had no clue about ETAP, rather she just knew what was right and wrong. Don’t all mothers have that uncanny instinct? Anyway, in this scenario it should be obvious that the quality, quantity and timing  of your pre-exercise meal should be considered

Possible Solutions: Wait 2-3 hours after a meal or consuming a large amount of fluid before engaging in vigorous physical activity. Just like Mom said. To reduce the amount of fluid in the stomach, drink small amounts frequently during the course of activity and avoid one large drink.

The second theory suggests that the stitch occurs from the stomach area  pulling on ligaments connecting to the diaphragm. It can occur when the stomach is sufficiently full of fluid adding to the pressure in the abdomen. It also appears that fluids containing dirrent forms of carbohydrate  can also have an impact on the incidence of the stitch. This is likely due to varying digestibility and absorption rates of different types of sugars used in the drinks. It has been found that sucrose and frutose are the biggest culprits, while plain old H2O and manufactured sweeteners such as maltodextrin result in the least incidence of side stitch.

Possible Solutions: It should be obvious that sports drinks containing glucose-polymers are a better choice than soft drinks and even sports drinks like Powerade that use a glucose-frutose blend, at least for preventing side stitches. Incidentally I eventually uncovered why I was getting stitches at the half way mark on the Grind; because that’s when I took a break and guzzled back half a bottle of Powerade. Within 10 minutes it hit me every time. Now I don’t drink anything. I just periodically bum some water from my girlfriend when the need arises. Aren’t I a nice guy?

Lastly, the third theory suggests that ETAP is related to inflammation of the parietal peritoneum when it becomes irritated. The peritoneum is the thin portion of connective tissue lining our abdominal region and encases most of the digestive organs and glands. It’s main job is  to protect and lubricate the entrails. Said irritation can elicit a sharp localized  pain.

I should also note that there are 2 types of side stitching that you can experience. The common “minor annoyance” kind that is related to food and beverage consumption. The other type is more severe and can be described as “extremely painful and debilitating”. This form is brought on by dehydration from insufficient fluid intake and or missed meals. Make sure you drink enough water to stay hydrated throughout the day.

In addition to adequate fluid consumption, you need to pay attention to pH levels, antioxidant intake and electrolyte balance . You must understand the quality and quantity of the fluids you require. At the very minimum, I recommend you get at least of 2-4 liters (depending on body weight and activity levels) of filtered water daily. Sadly, most people don’t even come close.

I hope this helps people understand this phenomenon a little better now. You don’t get them because you are out of shape but rather you failed to plan your food and liquid consumption properly.  And you know what they say ” If you fail to plan, you plan to fail”. Until next time, Stay fit and have fun!