Pushing through the pain cave
by TMR Sports Psychologist Dr Josephine Perry
I work with the Elite Trail Team (all ultra runners) and a number of other ultra runners and cyclists so am constantly on the lookout for new research to see if anything can help improve their performances or their enjoyment. I was really excited to see Lloyd Emeka & Carla Meijen’s (St Mary’s Uni in Twickenham) research published recently in the Sport and Exercise Psychology Review and thought it deserved a much wider audience. If you sign up to Research Gate you can read the full paper.
Emeka & Meijen studied the lived experiences of pain tolerance in six male ultra-marathon runners. Their findings highlight the real challenge that many of us in sport psychology, physiotherapy and physiology struggle with; how to help athletes distinguish between discomfort and real pain and the influence of socio-cultural norms on pain tolerance within ultra-running.
Key points they have pulled together from previous research:
Between 22–24% of ultramarathon runners experience musculoskeletal (MSK) pain during and after a race. This is actually similar to pain experience levels in 5k and 10k runners but the types of pain might be different than in shorter distance (a burning sensation in the muscles and lungs) than in a long distance (a gradual increase which manifests as general feelings of fatigue, exhaustion, and injury) runners.
Pain tolerance studies have highlighted male ultra-runners have higher levels of pain tolerance than active non ultra-runners.
Exercise-induced pain (EIP) is a type of pain that can naturally occur when athletes engage in intense exercise, does not cause lasting damage and will usually diminish or disappear shortly after intensity is ceased or reduced. Endurance athletes consider EIP as a fundamental aspect of their sport and recognise the need to push through discomfort to achieve the physiological adaptations necessary to improve their performance.
Pain tolerance is ‘the maximum level of perceived pain that someone is able to tolerate or the duration someone is willing to be exposed to a given pain intensity.’
Experienced distance runners are prepared to accept pain as an unavoidable and necessary component of training, and are willing to push their body to the limits
Despite the negative impact that can come with experiencing pain, ultra-runners appear to be willing to endure pain despite feeling bad or hurting and this might also be partially due to overcoming personal obstacles and experiencing feelings of personal accomplishment and euphoria after completing a race.
Interesting concept: The social meaning of pain in ultra runners:
The paper collated some ideas on the social meaning of pushing the limits of physical capacities in ultra-endurance athletes:
can be considered as a positive part of hard training for ultra-runners.
is part of a shared experiences of suffering with like-minded people.
embracing the suffering can build physical and psychological strength
helps them to derive the pleasure, enhanced self-esteem, and social kudos of their sport.
Four areas the authors found arose when examining the lived experiences of the six ultra-runners:
Building relationships with pain: This is about the development of a relationship with pain during the transition from novice to experienced ultra-runner. Participants described how pain became normalised as they gained more experience in ultra-marathon running, and this normalisation was attributed to physiological adaptations over time and increased self-understanding of bodily sensations so higher levels of pain tolerance were attained. “Your body almost sort of re-establishes a new baseline of pain.”
What is ‘real’ pain: ‘Real’ pain by these runners is seen as tissue damage or injury; a ‘primal’ pain. The type of pain that is expected and embraced in ultra-running is the discomfort or fatigue that is a direct consequence of pushing your body to the limit and so is temporary.
Gratification of pushing through pain: A feeling of instant gratification from pushing through pain was derived from stretching the boundary of perceived physiological and psychological limits. Resisting the physiological signals to stop running and push through was considered as an achievement in itself. The good feels from this may also be fed by the risk of self-doubt and self-criticism if the hardship was not endured. There is also an element here of ‘pushing though’ together creating a sense of community from having shared painful experiences with people’.
The trajectory of enduring hardship: There can be a strong tolerance of both pain and discomfort when there is a good reason (completing their first race) than might fade as the runner gets more experienced and wants to be able to perform in their races (and they don’t risk the ‘primal injury pain’. This maturity might mean the runner becomes more pragmatic as to when pain is worthwhile.
My key takeaways:
“The ability to distinguish between discomfort and real pain was not always a clear-cut process as the decision to push through perceived normal pain (e.g. discomfort) led to post-race injury, and real pain was experienced during a race but ignored in pursuit of a goal.”
Coaches might adapt their language whilst communicating with ultra-runners experiencing pain.
In training it might be beneficial for coaches to facilitate an alternative narrative to overcoming or tolerating pain.
In racing it might be helpful for coaches to help the athlete develop their self-awareness of what is discomfort and what is pain and where in a race a DNF call might be made.
This newsletter originally appeared on Dr Josephine Perry's website Performance in Mind. It contains many great resources, and is well worth visiting.
References:
Emeka, L., and Meijen, C. (2024). 'Pushing through the pain cave': Lived experiences of pain tolerance in male ultra-marathon runners. January 2024. Sport & Exercise Psychology Review 18(2):40 - 54. DOI:10.53841/bpssepr.2023.18.2.40