More than just a stitch?

[reevesie]

Hi all. I have a 15 year old male. Very sporty. 1st sport cricket (bowler) 2nd running 3rd cycling. Over the last 3months he has suffered with pain below ribs on left side and right shoulder. He describes the pain exactly like a stitch. The pain comes on after 800m of running and gets worse until running stops, certainly before 1200m. After stopping the pain will go away almost immediatly but then return almost with the first step, although if he has a few minutes rest then the pain will come back after a few steps. Small bounces without running recreated the pain. Cycling does not bring on the pain. Bowling, his run up is only 8 paces doesn't affect him.
we have tried to change his breathing pattern and introduce self massage just about the pelvic rim into the hip flexors all to no avail.
would be grateful for any advice. It does appear to me that it is the running motion that is creating stress somewhere.
thanks very much
mike

[neurospast]

Hi all. I have a 15 year old male. Very sporty. 1st sport cricket (bowler) 2nd running 3rd cycling. Over the last 3months he has suffered with pain below ribs on left side and right shoulder. He describes the pain exactly like a stitch. The pain comes on after 800m of running and gets worse until running stops, certainly before 1200m. After stopping the pain will go away almost immediatly but then return almost with the first step, although if he has a few minutes rest then the pain will come back after a few steps. Small bounces without running recreated the pain. Cycling does not bring on the pain. Bowling, his run up is only 8 paces doesn't affect him.
we have tried to change his breathing pattern and introduce self massage just about the pelvic rim into the hip flexors all to no avail.
would be grateful for any advice. It does appear to me that it is the running motion that is creating stress somewhere.
thanks very much
mike

Why do you give self massage in the hip flexor area? Reasoning?
Bowler: extreme body rotation towards 1 side only. pain below ribs on left side (at the back or front?) and pain at right shoulder (at back or front?) ; bowler right or left handed?, which area does he exactly have pain? (is there a specific painful spot (triggerpoint like or high toned muscles?) Running, bouncing causing aggravation (running style, arm swing?), not cycling (therefor likely that movement of the spine and ribs causing problem).
To test: general posture. AROM and PROM of the spine with specific emphasis on thoracic rotation and lumbar sideflex (but flex-ext can be as important). muscle length of QL, Latissimus Dorsi. Assumption of problem; triggerpoint or vertebral/costal misalignment likely in mid or lower thoracic area. But you did not give any information in where exactly the pain is located and if it is palpable or provocable by touch. Be aware that referred pain from the thorax can be referred in the abdominal area (see triggerpoints charts).
Before you get an answer we need to know far more....

[Vicki Lang]

This is probably ETAP -exercise induced transient abdominal pain or stitch. It occurs when the sport involves jolting(horse riders suffer from it) although swimmers also experience it. Current thinking is that the cause of this pain is irritation or friction to the parietal peritoneum. As this tissue is throughout the abdomen it can cause localised pain in various sites. The sub diaphragmatic portion of the parietal peritoneum is supplied by the phrenic nerve so this could explain shoulder tip pain. Friciton on this tissue can be caused by increased pressure in the abdomen such as distension after a meal or changes in fluid pressure in the abdomen. Management: fasting prior to exercise, wearing a tight belt, breathing through pursed lips with hyperinflated lungs. Pain may be relieved by bending forward and tensing abdominals. This pain gets less as one ages.

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This is probably ETAP -exercise induced transient abdominal pain or stitch. It occurs when the sport involves jolting(horse riders suffer from it) although swimmers also experience it. Current thinking is that the cause of this pain is irritation or friction to the parietal peritoneum. As this tissue is throughout the abdomen it can cause localised pain in various sites. The sub diaphragmatic portion of the parietal peritoneum is supplied by the phrenic nerve so this could explain shoulder tip pain. Friciton on this tissue can be caused by increased pressure in the abdomen such as distension after a meal or changes in fluid pressure in the abdomen. Management: fasting prior to exercise, wearing a tight belt, breathing through pursed lips with hyperinflated lungs. Pain may be relieved by bending forward and tensing abdominals. This pain gets less as one ages.