Exercise-Related Transient Abdominal Pain (ETAP)

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.

A review of analgesic and emotive breathing: a multidisciplinary approach

“…We can assume that a physiological function of the diaphragm muscle can somehow reduce the afferent nociceptive stimulation from the vagus nerve, or through adequate visceral pressure and/or proper functions of the viscera at the lowering of the diaphragm. 20 There is no scientific evidence to confirm this reflection at this time.…”

Abdominal pain related to pathology of peripheral nervous system

“…Происхождение боли недостаточно ясно, ее связывают с раздражением рецепторов связок внутренних органов, с преходящей ишемией диафрагмы и желудка, спазмом мышц брюшного пресса или раздражением спинномозговых нервов. Оптимизация положения тела, ношение поддерживающего пояса оказывают профилактический эффект [27].…”

Dietary Manipulations Concurrent to Endurance Training

“…A LCHF dietary approach has been explored by endurance athletes due to its ability to increase rates of fat oxidation and reduce reliance on CHO during prolonged exercise [ 12 ]. Fat metabolism during exercise is a complex process involving many sites of regulation that may be affected by dietary intake including the release of free fatty acids (FFA) from adipose tissue and delivery to working muscle, transport of fat into the cell, binding and transport of fat in the cytoplasm, transport of fat into the mitochondria, and the regulation of intramuscular triglyceride (IMTG) synthesis and breakdown [ 13 , 14 ]. A LCHF diet increases the release of FFA from adipose tissue at rest and during exercise [ 15 ], which can be transported to the muscles and oxidized or re-esterified and stored into the IMTG droplets located next to the mitochondria.…”