The endurance athlete's "stitch": Etiology and management of exercise-related transient abdominal pain

Abstract

Background: The endurance athlete's stitch, or exercise-related transient abdominal (ETAP), all too commonly limits the performance of endurance athletes, but its origin, management and possible methods of prevention remain unclear. Methods: Published research was reviewed systematically from January 1996 through May 2015.The terms Athletic Stitch, Pain in the side OR Abdominal pain were paired with Exercise/Exercise therapy, Physical education/Training, OR Fitness/Physical fitness to identify a total of 66 papers. 35 of these articles relevant to review objectives were supplemented by an additional 50 citations drawn from reference lists and personal files. Results : About a fifth of participants in aerobic endurance events are affected by ETAP on any one occasion, and perhaps two thirds of competitors experience ETAP at least once during a year. The risk seems greater in younger, less experienced and female athletes. Postulated causes that include visceral ischaemia, visceral vibration, ischaemia and/or spasm of the respiratory muscles, postural disorders, peritoneal irritation, and psychological factors.Treatment currently remains empirical. Optimizing physical condition, strengthening abdominal and spinal muscles, and avoiding food and hypertonic fluids immediately before an event appear to reduce the risks of ETAP. A slowing of pace, bending, local pressure and an abdominal binder may give immediate relief; the merits of spinal manipulation have yet to be confirmed Conclusions : Empirical remedies as yet have limited efficacy, and it remains necessary to develop a clear unifying hypothesis of etiology before evidence-based recommendations for the prevention and treatment of ETAP. Although ETAP may impair performance, it does not have any serious sequelae; the important objective for the practitioner is to distinguish it from other more dangerous causes of abdominal pain.