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Exercise-related transient abdominal pain (ETAP).

Morton D, Callister R - Sports Med (2015)

Bottom Line: Several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum.Techniques for gaining relief from the pain during an episode are equivocal.This article presents a contemporary understanding of ETAP, which historically has received little research attention but over the past 15 years has been more carefully studied.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Education and Science, Lifestyle Research Centre, Avondale College of Higher Education, PO Box 19, Cooranbong, NSW, 2265, Australia, darren.morton@avondale.edu.au.

ABSTRACT
Exercise-related transient abdominal pain (ETAP), commonly referred to as 'stitch', is an ailment well known in many sporting activities. It is especially prevalent in activities that involve repetitive torso movement with the torso in an extended position, such as running and horse riding. Approximately 70% of runners report experiencing the pain in the past year and in a single running event approximately one in five participants can be expected to suffer the condition. ETAP is a localized pain that is most common in the lateral aspects of the mid abdomen along the costal border, although it may occur in any region of the abdomen. It may also be related to shoulder tip pain, which is the referred site from tissue innervated by the phrenic nerve. ETAP tends to be sharp or stabbing when severe, and cramping, aching, or pulling when less intense. The condition is exacerbated by the postprandial state, with hypertonic beverages being particularly provocative. ETAP is most common in the young but is unrelated to sex or body type. Well trained athletes are not immune from the condition, although they may experience it less frequently. Several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum. Of these theories, irritation of the parietal peritoneum best explains the features of ETAP; however, further investigations are required. Strategies for managing the pain are largely anecdotal, especially given that its etiology remains to be fully elucidated. Commonly purported prevention strategies include avoiding large volumes of food and beverages for at least 2 hours prior to exercise, especially hypertonic compounds; improving posture, especially in the thoracic region; and supporting the abdominal organs by improving core strength or wearing a supportive broad belt. Techniques for gaining relief from the pain during an episode are equivocal. This article presents a contemporary understanding of ETAP, which historically has received little research attention but over the past 15 years has been more carefully studied.

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The location of exercise-related transient abdominal pain (ETAP) reported by the combined symptomatic subjects (N = 818) in the studies by Morton and Callister [1] and Morton et al. [12]. Note, some respondents reported ETAP in more than one position. L left, R right
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Fig1: The location of exercise-related transient abdominal pain (ETAP) reported by the combined symptomatic subjects (N = 818) in the studies by Morton and Callister [1] and Morton et al. [12]. Note, some respondents reported ETAP in more than one position. L left, R right

Mentions: In approximately 80 % of cases, the pain is described as localized rather than vague and diffuse [1, 12]. While the pain is mostly localized during an episode, it may occur in any region of the abdomen [1, 12], with pain in the mid- to upper-abdomen, especially along the costal border, being the most common site as shown in Fig. 1 [1–3, 12, 18, 19]. Right side pain has been reported as up to twice as common as left side pain [12, 16], although left side pain may be more prevalent among the young [1, 5, 11].Fig. 1


Exercise-related transient abdominal pain (ETAP).

Morton D, Callister R - Sports Med (2015)

The location of exercise-related transient abdominal pain (ETAP) reported by the combined symptomatic subjects (N = 818) in the studies by Morton and Callister [1] and Morton et al. [12]. Note, some respondents reported ETAP in more than one position. L left, R right
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4281377&req=5

Fig1: The location of exercise-related transient abdominal pain (ETAP) reported by the combined symptomatic subjects (N = 818) in the studies by Morton and Callister [1] and Morton et al. [12]. Note, some respondents reported ETAP in more than one position. L left, R right
Mentions: In approximately 80 % of cases, the pain is described as localized rather than vague and diffuse [1, 12]. While the pain is mostly localized during an episode, it may occur in any region of the abdomen [1, 12], with pain in the mid- to upper-abdomen, especially along the costal border, being the most common site as shown in Fig. 1 [1–3, 12, 18, 19]. Right side pain has been reported as up to twice as common as left side pain [12, 16], although left side pain may be more prevalent among the young [1, 5, 11].Fig. 1

Bottom Line: Several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum.Techniques for gaining relief from the pain during an episode are equivocal.This article presents a contemporary understanding of ETAP, which historically has received little research attention but over the past 15 years has been more carefully studied.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Education and Science, Lifestyle Research Centre, Avondale College of Higher Education, PO Box 19, Cooranbong, NSW, 2265, Australia, darren.morton@avondale.edu.au.

ABSTRACT
Exercise-related transient abdominal pain (ETAP), commonly referred to as 'stitch', is an ailment well known in many sporting activities. It is especially prevalent in activities that involve repetitive torso movement with the torso in an extended position, such as running and horse riding. Approximately 70% of runners report experiencing the pain in the past year and in a single running event approximately one in five participants can be expected to suffer the condition. ETAP is a localized pain that is most common in the lateral aspects of the mid abdomen along the costal border, although it may occur in any region of the abdomen. It may also be related to shoulder tip pain, which is the referred site from tissue innervated by the phrenic nerve. ETAP tends to be sharp or stabbing when severe, and cramping, aching, or pulling when less intense. The condition is exacerbated by the postprandial state, with hypertonic beverages being particularly provocative. ETAP is most common in the young but is unrelated to sex or body type. Well trained athletes are not immune from the condition, although they may experience it less frequently. Several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum. Of these theories, irritation of the parietal peritoneum best explains the features of ETAP; however, further investigations are required. Strategies for managing the pain are largely anecdotal, especially given that its etiology remains to be fully elucidated. Commonly purported prevention strategies include avoiding large volumes of food and beverages for at least 2 hours prior to exercise, especially hypertonic compounds; improving posture, especially in the thoracic region; and supporting the abdominal organs by improving core strength or wearing a supportive broad belt. Techniques for gaining relief from the pain during an episode are equivocal. This article presents a contemporary understanding of ETAP, which historically has received little research attention but over the past 15 years has been more carefully studied.

Show MeSH
Related in: MedlinePlus