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The cause of the abdominal pain commonly referred to as “stitch”, but more accurately known as exercise related transient abdominal pain (ETAP), had until recently attracted more speculation than research. Explanations for the pain have included diaphragmatic ischaemia,1 stress on peritoneal ligaments,2 and irritation of the parietal peritoneum.3 Although the exact cause of the pain remains to be elucidated, a neurogenic explanation has not appeared in the literature.
We present the case of an elite runner who, after a thoracic spine trauma, developed severe and recurrent episodes of ETAP which were relieved by localised treatment. As a follow up study, we made observations on 17 other runners who often experience episodes of ETAP and found that palpation of specific facet joints could reproduce symptoms of ETAP shortly after an episode of the pain had been relieved.
The patient was a 25 year old man who had been actively involved in competitive running for about 16 years. During this time, he claimed that he occasionally experienced mild symptoms of ETAP during training and competition, although they were not disruptive to performance. After trauma to the thoracic spine in a trampoline accident, he began to experience ETAP with greater frequency and severity. Subsequently he would develop ETAP …