You Have More In Your Stomach Than You Think!
A natural reaction to pain or discomfort in the abdominal region is to assume something is going wrong with your internal organs. There’s some pretty important things in there. Liver, kidney, stomach, appendix to name but a few and many of these are covered in the link we mentioned in terms of theories relating to what stitch actually is. Ripe for a good bit of catastrophising worrying about what internal organ is failing us and our impending doom. But did you know there are lots of muscles running through that area?
Many of the theories around stitch involve the diaphragm and I would tend to agree with that from what I have seen clinically. Particularly if we consider the following picture of the musculature through the abdominal region based on cadaver studies done by the guys at Anatomy Trains:
For anyone wanting to use our representation of this image we simply ask for a link back to our website in return. You can see the sheer amount of musculature that sits in and around our internal organs. In our experience it is this these muscles that are mostly to blame for the sensations we call stitch.
You can see in the picture of the Deep Front Line here to the left that the diaphragm is entirely continuous with the hip flexors (psoas and iliacus) the muscles that lift our legs up. Our thought is that it is dysfunction of these muscles that contributes to most of the pain associated with stitch.
Why are we so sure? Because we fairly consistently see evidence for it. Usually when we release the muscles off using our jiggery pokery we will help people make a full recovery from their stitches. Obviously we can’t guarantee it will work for everyone. And there are certain circumstance where it won’t. For example if these muscles are being held tight by ongoing stress or anxiety. Which is why we like to turn our attention to what’s going on in the mind as part of the work we do. See previous Mindbody article for more details.
For the rest of us a good release of hip flexors and diaphragm will normally see us right.
Does A Full Stomach Cause Stitch?
We all know (I hope!) the standard advice to avoid stitch. Don’t eat too much before exercise. So does this mean it’s your stomach that’s the problem? I’d say that sure the stomach can affect things. I think we all instinctively know that if we eat a big meal we’re more likely to get stitch. But for me that still doesn’t confirm that it’s the stomach to blame.
To my mind the stomach is bigger when full of food. The more food the bigger it is. The bigger it is the more it gets in the way of our breathing (diaphragm) and hip flexor (psoas, iliacus) muscles. Therefore reducing the amount of room they have to manoeuvre. And potentially pressing on the tight over worked bits of muscles that are causing the pain.
Why am I so convinced it’s the muscle that’s causing the pain and not the stomach. Because so many people have reported that when I release a tight muscles in their stomach it matches the sensation that they associate with their stitch.
What Can I Do About My Stitch?
Now onto the good stuff. What can you do about your stitch issues? Thankfully lots. We’ll give you our information here for free (you’re welcome!) but is this no substitute for having it professionally assessed by your local Physiotherapy and Sport Therapy clinic. Other clinics other than our own are of course available!
Make Sure Your Working Efficiently
So this is our thing. There can be a whole myriad of biomechanical reasons the muscles through your stomach are working too hard and causing stitch. We like to assess and release each of them with the work we do in the clinic. Most commonly it will be caused by breathing a bit too tense due to prolonged periods of stress, current or past.
Or it could be simply using the muscles that lift the legs up (hip flexion) too much. Too much for what your body is capable of. Perhaps increasing your training too quickly. Or conversely training too hard to too long…
Over-exertion is what makes muscles grumpy. If there not conditioned that’s fair enough. But if you’re super fit surely they should be conditioned enough. But actually no. If you continue to overtrain and don’t give your muscles the chance to recover and rest then the opposite of what we’re trying to achieve happens. That is that the muscles starts to degrade, not get stronger.
As we talk about in our previous Peak Performance article it’s important that your training regime is sustainable without burning out. If this is you please read that article and the book it is based on. One of the core principles to performing at our best is keep training at a sustainable level. Not trying to achieve too much too soon and burning out with injury, fatigue or loss of interest.
Reduce Stress Levels To Reduce Stitch?
Another source of knots, tightness and lack of function in the diaphragm and psoas is stress and posture. For me the two go hand in hand. When we are stressed, tired or run down that is reflected in our posture. Conversely there’s a lot of research which suggest that posture will effect our mood and our emotion – check out excellent TED Talk on the subject.
How do you reduce your stress levels? Well you’re probably in the best position to work out how to do that. But in our Mindfulness article we have lots of ideas on how you might try to do such a thing. And in our bad habits article things that help us avoid being relaxed!
As for posture here’s our latest thoughts on how best to sit from our previous hernia article. The same principles apply when trying to sit in the best position to give your diaphragm and hip flexors enough room to do their thing:
Relax And Breath To Release Your Stitch
One of the most effective ways we’ve found to relax is relaxation breathing. Many of the theories of what stitch is relate to the diaphragm so it stands to reason that if the diaphragm is doing it’s thing better then this will help your stitch. We see evidence of this in the clinic when we help release people’s diaphragm we normally see an improvement in symptoms. If you’re new to relaxation breathing here’s a demonstration of one way to do it:
Try to practice breathing as shown daily and build it into a routine. If you’re new to this we recommend starting with 2-5 minutes 3 times per day. When you know where your diaphragm is and how to use it try to notice how you are breathing during your day. Are you using your diaphragm? Or do you shallow or rib breathe? This is more fight or flight and suggestive of increased stress levels. It’s ok to go there. We need to. But when we do we need to notice and bring the breath back into our tummy and focus on a nice long outbreath to clam our nervous systems and release tension in our diaphragms.
Release Your Own ‘Stitch’ Muscles
There’s no substitute of a professional doing this but if you’d like to try one of our techniques for releasing off your ‘stitch’ muscles yourself have a look at the following video. We can’t do it as well to ourselves as we can other people, but you will at least get some of the benefit and get a sense if this kind of approach will help you. Don’t be too brutal too yourself. Start gently.
Stretch Those Stitch Muscles
There are multitude of stretches for your hip flexors. For those into yoga any kind of sun salutation or cobra will be useful. Here’s a video of our favourite hip flexor stretch. Never do any stretch to pain. It defeats the point. The muscles will not be able to relax. Stretching should be enjoyable and comfortable. Use your breathing to relax into this stretch. If you can’t do it without pain then don’t do it:
Don’t Eat Too Much Before Exercising
And of course finally the piece of advice I hope you already knew. Make sure your belly is not too full. With food or liquid. Everyone is different and some people can tolerate more in the stomach than others for exercising. As a type 1 diabetic I’ve had to learn to be able to exercise with some food in my stomach, or sugar at least. You’ll know what works best for you. Trust your instincts. It’s a little bit of trial and error too.
Is It Actually Stitch?
Just to complete the picture I wanted to mention another category that isn’t stitch but can be equally if not more debilitating. It’s a feeling in the stomach like a nervous or anxious feeling. It can make you feel like you’re permanently on edge. It can even make you feel nauseous. It can in itself cause stomach cramp and contribute to irritable bowel syndrome (IBS).
This is another one that suggests you’ve been doing too much or had an increased stress levels over a prolonged period. This is because these sensations wholly or in part come from you adrenal glands which sit just on top of your kidneys. These lovely glands are absolutely essential for normal bodily function. But if they start giving you the sensations we describe above you may want to slow down a bit.
Conclusion on Stitch
If you’re genuinely concerned and in lots of pain and particularly if you have a general feeling of being unwell then get checked over by your doctor. People like ourselves are next in line when anything serious has been ruled out and we can get to work on releasing those tight muscles that are contributing to your stitch symptoms.
If you’d like to know if we can help with your stitch symptoms or anything else for that matter give us a call on 01273 921831 or mail us at info@BrightonSportsTherapy.co.uk. For the rest of you, work on that posture, look after yourself, don’t get too stressed and exercise hard but allow yourself rest and recovery.
Please click the following link if you’d like more information about our Brighton Physiotherapy & Sports Therapy.