Sports related activity or habitual tension and hyperventilation can trigger side stitches

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Side Stitch Pain, No Laughing Matter

Has anyone ever made you laugh so hard they left you in stitches? Today we are addressing a pain syndrome know as "Side Stitches".  Side stitch pain is no laughing matter if you've ever experienced it. It is characterized as a sharp, stabbing pain, and a feeling of being restricted when trying to breath deeply. The pain is felt at lower end of the rib cage and can also send referring pain to the back just under the shoulder.  Serratus anterior is the muscle we find as the main culprit in this syndrome.  The pain is felt when movement in the diaphragm muscle is restricted by trigger points during deep inhalation. The diaphragm is a dome shaped muscle that separates the thoracic (lung) cavity from the abdominal cavity and moves up and down when you inhale and exhale.

This syndrome is experienced by, commonly, the weekend sports enthusiast; hyperventilation and habitual tension due to respiratory illness or prolonged emotional stress.

During vigorous athletic activity, when you need to take quick breaths, the serratus anterior muscles assist in respiration by pulling the ribs to expand the chest.  These muscles  are also in involved in arm and shoulder movement in actions such as push-ups, weight lifting, horse back riding, chin ups and tennis. If you are a person not normally engaged in regular recreation activities, these muscles can easily become over taxed due to over exhersion. 

One remedy to avoid side stitch in this case is to properly warm up before activity, concentrate on deep breathing during exercise, gradually build up workout intensity and increase fluids during activity. In the case of prolong emotional stress, a key is to become more acutely aware of how you maybe holding your breath during stressful times. This action can help minimize the formation of trigger points in the diaphragm muscles which is turn restricting the movement of the rib cage.

Once you have brought this to your awareness, practice letting go and take deep full breaths to allow your body to ease tension. Trigger point therapy, a type of medical massage, is also very helpful in helping to alleviate pain and discomfort. 

What is a groin pull?
A groin pull is an injury to the muscles of the inner thigh. The groin muscles, called the "adductor muscle" group, consists of six muscles that span the distance from the inner pelvis to the inner part of the femur (thigh bone). These muscles pull the legs together, and also help with other movements of the hip joint. The adductor muscles are important to many types of athletes including sprinters, swimmers, soccer players, and football players.
What happens to the muscle with a groin pull?
A groin pull is an injury to the adductor muscles called a muscle strain. When a muscle is strained, the muscle is stretched too far. Less severe strains pull the muscle beyond their normal excursion. More severe strains tear the muscle fibers, and can even cause a complete tear of the muscle. Most commonly, groin pulls are minor tears of some muscle fibers, but the bulk of the muscle tissue remains intact.
What are the symptoms of a groin pull?
An acute groin pull can be quite painful, depending on the severity of the injury. Groin pulls are usually graded as follows:

• Grade I Groin Strain: Mild discomfort, often no disability. Usually does not limit activity.
• Grade II Groin Strain: Moderate discomfort, can limit ability to perform activities such as running and jumping. May have moderate swelling and bruising associated.
• Grade III Groin Strain: Severe injury that can cause pain with walking. Often patients complain of muscle spasm, swelling, and significant bruising.

Groin pulls are often seen in athletics who participate in sports such as ice hockey and soccer. The injury appears to be related to factors including hip muscle strength, preseason conditioning, and previous injury. Because of this, proper conditioning is of utmost importance to prevent the occurrence of a groin strain injury. Athletes, especially hockey and soccer players, should incorporate adductor strengthening, pelvic stabilization, and core strengthening exercises into their workouts to prevent the occurrence of a pulled groin. What other problems can cause similar symptoms?
A pulled groin is usually a clear diagnosis. Most athletes know what the injury is before they seek medical attention. However, other conditions can mimic the symptoms of a groin strain.
One condition that was previously not well recognized is called a sports hernia. Sports hernias have been found in patients who were diagnosed with chronic groin strains. The sports hernia is a condition similar to a regular inguinal hernia, and is due to a weakening of the muscles that form the abdominal wall. The symptoms of a sports hernia are often nearly identical to those of a groin strain. For more information:

• Sports hernias
• Inguinal hernias   

 Other conditions that may mimic the symptoms of a groin strain include osteitis pubis (inflammation of the pubic bone), hip joint problems (including early arthritis, labral tears, and other conditions), and low back problems (pinched nerves). When do I need to see a doctor for a groin pull?
If you have symptoms of a severe groin pull, you should be evaluated for proper treatment. Some signs of a severe groin strain include:

• Difficulty walking
• Pain while sitting or at rest
• Pain at night

Severe groin pulls should be evaluated because in some very rare situations of complete muscle rupture, surgery may be necessary to reattach the torn ends of the muscle. This is rarely needed, even in patients with Grade III groin strain injuries, as these patients can usually undergo successful non-operative treatment. If you are unsure if you have a groin pull or the symptoms do not quickly resolve, then you should be seen by your doctor. As described above, other conditions can be confused with a groin pull, and these should be considered if your symptoms do not resolve. Once a strain is diagnosed, you can begin treatment for your groin pull.
Treatment of a groin pull is usually guided by the severity of the injury. Resting a groin pull is the key to successful treatment. As a general rule of thumb, if you have a groin pull, you can do activities that don't aggravate your injury. You should rest until you are pain free to allow the injured muscle to heal. Resting inadequately may prolong your recovery.
The following are the common treatments used for groin strains:

• Rest
  It is important to rest following the injury to allowed the injured muscle to properly heal. Allow pain to guide your level of activity; this means that activities which cause symptoms should be avoided.
• Stretching
  Gentle stretching is helpful, but it should not be painful. Stretching excessively can be harmful and slow the healing process.
  • Adductor stretches
• Ice the Injury
  Apply ice to the injured area in the acute phase (first 48 hours after injury), and then after activities. Ice will help calm the inflammatory response and stimulate blood flow to the area.
• Heat Applications
  Before activities, gentle heating can help loosen the muscle. Apply a heat pack to the groin prior to stretching or exercising. As a general rule of thumb, remember to heat before, and ice after.
  • Know when to ice and when to heat an injury
• Anti-inflammatory Medications
  Oral anti-inflammatory medications (such as Ibuprofen, Aleve, or Motrin) can help relieve symptoms of pain and also calm the inflammation.
• Physical Therapy
  Physical therapists can be helpful in guiding treatment that may speed your recovery. Some people find modalities such as ultrasound, therapeutic massage, and specific exercises particularly helpful. You should see your physician to determine if these would be appropriate for your condition.

What can be done to prevent groin strains?
New research is shedding light on factors that can be helpful in preventing groin injuries. Competitive athletes who participate in soccer, ice hockey, or similar sports that are prone to groin injuries should focus some energy on groin injury prevention. Exactly what exercises and stretches are most important in still being worked out, but some suggestions for groin injury prevention include:

• Adductor stretching
• Hip adductor and abductor strengthening
• Pelvic stabilization exercises
• Core stability, including abdominal and lumbar strengthening

Together, these exercises and stretches can help control the movements of the hip and pelvis, and hopefully prevent many groin strains. _Sources: