It’s annoying, it’s painful, but where on Earth is it coming from? I was reading a medical article which has inspired me to my latest Blog. It was by a Doctor who clearly knew their beans. Having been asked the causes of “Stitch” they went into a long explanation of the which internal organ was where and what that might mean if you have pain in certain parts of your stomach. I’m sure he was spot on, but it was a pretty scary read!
Before you go rushing off to A&E, fear not. Thankfully, in our experience, most pain in the abdomen region is actually a very curable muscular issue. And certainly no cause for any unnatural internal examinations! That said, if you’re rolling around in agonising stomach pain best pop to A&E… if you’re irritated by pain, tightness or stitch in the stomach then read on.
No offence! But 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. Ripe for a good bit of catastrophisation! But do we know what muscles run through that area?
If I mentioned Psoas, Iliacus, Quadratus Lumborum, Obliques Internus and Externus would you know what I was prattling on about? These are simply the muscles that are mixed in with all these internal organs in our stomach and perform important muscular function. Take for example lifting your leg up. Pretty important huh? Try running or walking without lifting your leg up – pretty difficult hey?
N.B. We have seen a few clients over the years have a damn good go at running / walking without lifting the leg up. They shall of course remain nameless but lets just say the bio-mechanics weren’t pretty. They are of course all functioning perfectly now!
The Traditional Advice
Now we all know (I hope!) the standard advice to avoid stitch. Don’t eat too much before exercise. Don’t go swimming on a full stomach. But you can still get stitch if you don’t eat before exercise. So why would this be important? Obviously consuming food makes the stomach bigger. But what’s so different in exercising versus just sitting around and digesting your food normally.
Movement of course. And where does the movement come from? Muscles. In the case of lifting the leg up, the Psoas muscle performs this function which sits right next to the stomach and is continuous with the peritoneum (the sack containing the internal organs). So this is why the combination of movement and a full stomach gives us pain and discomfort, “stitch.”
Relax And Breath
Now if I told you that the Psoas muscle is connected to the Diaphragm which helps the lungs draw in air it wouldn’t be a massive surprise that we tend to get stitch when we are exercising and breathing hard. In fact many of the anecdotal advice for stitch is to relax the breathing. So this makes sense.
But if it’s just down to breathing hard and lifting your legs up why do some people have problems and most people don’t? Well it’s all to do with how hard the muscles are working. Stitch, on our experience, is just like cramp and occurs when these muscle are simply working “too hard”.
My What Is Working Too Hard?
Your Deep Front Line. Yes, sorry, time to get technical. For those of a geeky nature like myself have a click here to see for yourself. This shows the connection of the Psoas and Diaphragm the unit that helps you breath is continuous with the structure that lifts your leg up. So something in here is working too hard.
This could be simply just to do with doing too much too soon. More than your body has done for a long time. And certainly more than it is capable of. This is quite common and explains when people get stitch when they are really blowing!
But fit people still get problems, sometimes when they are not exercising that intensively. So what’s happening here? This is usually due to muscular knots or tightness in the diaphragm and / or the psoas (hip flexor). A 30% increase in muscle tightness leads to 100% loss of function. Now there are always more parts of the muscle that will work. But then they have additional load and tire out. Before you know it the whole muscle really isn’t doing what it should very well at all!
Where Have These Knots Come From?
Previous over-exertion is the simplest explanation. If you’ve trained really hard previously and not given your body enough time to recover. But realistically how many us train that hard? Elite athletes certainly. High quality amateurs yes. The rest of us… unlikely!
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. Perversely there’s a lot of research coming out now which suggest that posture will effect our mood and our emotion – check out this brilliant (and I mean brilliant!) TED Talk on the subject.
I’ve Got A Bad Feeling About This!
Bonus points if you recognised the geeky Star Wars quote! 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 which is why I include it here. It can be a bit like a nervous feeling. Anxious too. It can make you feel like you’re permanently on edge. It 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 increase in stress levels. 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 and pay us a visit!
Run That By Me Again
So, as always, clear as mud. There are many different factors that contribute to discomfort in the stomach or abdomen region. The least likely of these is something internal and nasty – at least in our experience. The main factors are as follows:
- Stress – How busy have you been? Much going on? Any work or relationship issues?
- Increase In Exertion – Have you smashed it too soon?! Maybe your body isn’t quite ready for what you’re trying just yet
- Dodgy Bio-Mechanics – Maybe your body’s just not quite functioning right
- Full belly – leave off the pies before exercising!
What Can I Do About It?
As mentioned previously if you are 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.
For those in pain and discomfort who are concerned what it might be but don’t have any other symptoms then pop in and see us and we can assess and confirm if it’s a muscular problem we can help with – in most cases it is. If you’d like to know if we can help call us now on or mail us at info@BrightonSportsTherapy.co.uk.
For the rest of you, sit up straight, don’t smash the exercise too hard too soon and stay chilled and everything will remain tickety-boo!
If you’d like more information about our Brighton Physiotherapy services please click the previous link.