why do you get a stitch in your side

What causes a 'stitch'? by It's the pain in the torso that can dash athletes' hopes of winning races and turn some of us mere mortals off exercise altogether. But what causes a stitch and what can you do about it? Do you like to get active but find getting a stitch can stop you in your tracks? A stitch is a pain in the abdomen (usually on the side) that's brought on by activity and it's the bane of many runners' lives. It can range from sharp or stabbing to mild cramping, aching or pulling, and may involve pain in the shoulder tip too. And it often leaves you with no choice but to slow down or stop. It can dash hopes of winning races and put couch potatoes off donning running shoes in the first place. But stitches also afflict swimmers, horse-riders and even motor-cyclists, says Dr Darren Morton, an Australian scientist who is somewhat of a world authority on the phenomenon. Morton, a senior Lecturer in the Faculty of Education and Science at Avondale College of Higher Education in NSW, himself suffered stitches quite badly in his earlier athletic career as an ironman, triathlon and surf lifesaver. "I consulted fairly broadly and no-one seemed to have much an idea what caused them so it just seemed like a perfect topic to explore further," he says. He went on to do his PhD on stitches and has been involved in numerous studies since. Indeed,
in the journal Sports Medicine last year. He's now "99 per cent sure" that what's really behind a stitch is an irritation of the membrane lining the abdominal cavity and that what (and when) you eat and drink before you get active can raise or lower the odds of having one.


The membrane lining the abdominal cavity is known as the peritoneum. It is a double-layered membrane, with the outer layer lying tight against the front abdominal wall and folding around under the diaphragm, the dome-shaped sheet of muscle that separates your chest from your abdomen. The inner layer of the membrane wraps around the contours of the abdominal organs. Between the two layers is a small amount of fluid, which helps reduce friction when your organs shift as your body moves. Morton's theory is that this protective system sometimes goes wrong, and there is friction between the layers, resulting in irritation and the pain we call a stitch. The lining under the diaphragm is attached to the phrenic nerve, which refers pain to the shoulder tip region, which may explain why some people get shoulder tip pain with a stitch. The irritation can be triggered by pressure from the inside when organs, such as your stomach, are very full and swollen. But it can also happen when the amount of fluid in the space between the two layers drops. One thing we know can cause this is drinking concentrated fluids such as sugary drinks. "What we know is that things like really sugary drinks draw fluid out of that space and are very provocative of stitches," Morton says.


In experiments where people are given such drinks, like fruit juice or soft drink, and then asked to exercise "everyone sort of keels over left, right and centre with a stitch", he explains. Sports drinks, which are around 6 per cent sugar (compared to around 11 per cent for fruit juice), don't have this effect. In fact, they are no worse than water at bringing on a stitch. Sugary drinks have a "double whammy" effect reducing the rate at which the stomach empties its contents into the intestines, which may lead to bloating and further friction through direct pressure. While high fat foods also slow the emptying of the stomach, and hence help to bring on stitches, they're less frequently eaten before exercise than high sugar food and drinks. "We've got no evidence of anyone dying from stitches, so in that regard, they're relatively benign," Morton says. But they're still a widespread problem. "Over the years I've had hundreds of emails from people saying 'please help me, I've got some big event [coming up]'. And I know plenty of people who say 'I don't want to go for a run because I always get a stitch'. So what are stitches doing from a public health perspective? " The stitches that plagued Morton in his youth are no longer an issue. This fits with the general finding that people tend to grow out of stitches "probably because the nature of our tissues changes as we age," he says. "I very seldom get stitches now and I used to get really debilitated by them.


I used to get them just walking around. It probably just indicates I'm growing old or I'm not running fast enough. " While running or walking briskly, nearly everyone has experienced the sharp pain in the side known as a stitch. Side stitches are muscle spasms of the diaphragm, and they occur occasionally during strenuous exercise. Most people experience stitches on their right side, immediately below the ribs. A sudden sharp pain during exercise that occurs below the bottom of the ribcage, usually on the right side, and fades once exercise stops. What Causes Side Stitch? No one is quite certain why stitches occur, though thereБs no shortage of educated guesses. One theory is that the diaphragm (the large dome-shaped muscle that separates the chest cavity from the abdominal cavity) sometimes fails to receive enough blood during its contractions, and much like a leg cramp, this results in spasm and pain. What If You Do Nothing? Side stitches will go away on their own. Stop or slow down. Then bend forward and push your fingers into the painful area. These actions will force the diaphragm to relax and ease the spasm by increasing blood flow. Breathe deeply and exhale slowly. This should help relax the diaphragm. Stretch the abdominal muscles. Reach overhead and hold your arms in this position until the stitch disappears. DonБt eat and run. If stitches seem to hit you after a meal, wait 30 to 90 minutes after eating before you exercise.


Before and during exercise, refrain from drinking concentrated fruit juices and beverages high in carbohydrates (such as added sugars). Decrease the intensity and increase the duration of workouts. This is especially true if you are just starting an exercise program. Stitches are more common in untrained exercisers than in well-trained athletes. If you increase your fitness level gradually, you can sidestep stitches. Warm up before exercising. Begin with five to 10 minutes of gentle jogging or calisthenics. Avoid shallow breathing. Shallow breathing uses only a small portion of your total lung capacity. When this occurs as you run, the diaphragm doesnБt descend far enough to allow the connective ligaments of the liver to relax, possibly causing a stitch. Practice deep breathing exercises. Lie down on the floor and place a hand on your abdomen. Breathe in deeply. You are Бbelly breathingБ if you feel your hand rise slightly. If only your chest moves up, you are not breathing deeply enough. Try forced exhalation. As you run, periodically pretend you are blowing out candles. To do this, purse your lips while exhaling. This causes you to breathe deeply. This is a minor inconvenience that does not need medical attention. The Complete Home Wellness Handbook John Edward Swartzberg, M. D. , F. A. C. P. , Sheldon Margen, M. D. , and the editors of the UC Berkeley Wellness Letter

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