Pain is inevitable; suffering is optional.
A person’s pain tolerance refers to how much pain they can reasonably handle. But some people have a much higher pain tolerance than others. The question is why? And can we somehow increase ours?
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| 'Physical Suffering' during a 90-km ultra in the Alps |
How and why a person experiences pain can vary greatly, and the nature of how humans feel pain is complex. A number of factors influence an individual’s pain tolerance levels including genes, age, and gender, but the most widely held explanation is that the main differences are psychological, versus some type of physiological numbing of pain sensors. This could indicate that pain tolerance is trainable. So there is no reason to throw in the towel if you don't reach the finish line of your first ultra. If you are willing to work at it, there is reason for hope, as research indicates that seasoned endurance athletes have a remarkably higher tolerance for pain than others.
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| Mentally preparing for the last 10k of the 100km-Biel race |
A Germany study by Wolfgang Freund on pain tolerance asked ultra-endurance runners and non-athletes to submerge their hands in ice water for as long as possible. Non-athletes lasted an average of 96 seconds before giving up; whereas the runners made it to the three-minute safety cut-off at which point they rated the pain only 6 out of 10. This research was confirmed in a study at Norway’s University of Tromso that compared national-level soccer players with elite endurance athletes and non-athletes. As expected, the endurance athletes displayed higher pain tolerance than the non-athletes but, surprisingly, also more than the soccer players.
But why is that so? Are endurance athletes endowed with a genetic disposition to a high tolerance for pain? Or have years of training increased their comfort in the ‘pain cave’?
The ‘pain cave’ is an expression that is used by athletes, which refers to the point where the physical activity seems impossibly difficult. It describes a physical and mental state, rather than an actual physical location. People may refer to this differently. I tend to refer to it as having a ‘low’. Everyone goes through highs and lows during a race, and once you’ve gotten through a low, essentially beaten the ‘pain cave’ in a test of mental resilience, the next time you find yourself in one, you’ll have more mental arsenal to beat it. The idea is that pushing through physical discomfort is a mental skill. This is usually associated with a sense of reward. Thus, there has to be some passion involved that pushes you above and beyond the suffering in order to achieve a desired goal.
If ultra runners’ higher pain tolerance and reduced pain-related anxiety are at least partly the result of engaging in ultra running, a question arises regarding the mechanism by which ultra running has these effects. One possibility is that regular exposure to significant amounts of pain while training for and competing in ultramarathons leads to changes in pain-related psychological processes, which in turn mediate ultra runners’ increased pain tolerance. It has been speculated that regular exposure to intense pain may force them to develop efficient pain-coping strategies. We as humans use many different types of coping strategies to get us through difficult times in life. And similar strategies are used to get us through the ‘pain cave’. Coping strategies are numerous, but for simplicity, they are categorized here into two groups:
Maladaptive coping techniques (also termed non-coping) are often used to quickly reduce symptoms while maintaining or strengthening the stressor. Examples of maladaptive behavior strategies include dissociation, sensitization, safety behaviors, anxious avoidance, rationalisation and escape (including self-medication). Maladaptive techniques are only effective as a short-term rather than long-term coping process and a recent study in multistage ultramarathon runners has shown that ultra runners who use fewer maladaptive techniques are more likely to reach the finish line.
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| Freezing and Tired On Base Camp Mt. Everest Trek |
A problem-focused approach begins by finding out information about the problem and learning new skills to manage it. For example, a runner who repeatedly trains over long distances, battling those highs and lows and thereby increasing their level of experience, has removed some of the ‘unknowns’ involved in pushing their pain limits. Other examples of this type of information gathering in ultra running are researching gear options as well as reading race reports of other runners who have gone through such experiences which then provide a clearer idea of what to expect for one’s own self.
Emotion-focused coping is a mechanism to alleviate distress by minimizing, reducing, or preventing, the emotional components of a stressor. These strategies include:
• accepting responsibility
• exercising self-control
• distancing
• positive reappraisal
Humor can also be used as an adaptive coping strategy whereby stressful experiences can be minimized. Physiological processes are also influenced with humor; for example, laughing may reduce muscle tension, increase the flow of oxygen to the blood, exercise the cardiovascular region, and produce endorphins in the body. And who hasn’t experienced the way a good laugh takes your cares away, and time seems to ‘fly by when you are having fun’?
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| Relief at the finish line |
How do I apply these principles while running in the pain cave?
1. Remember your goal. Focus on why you are out there. Take one step at a time. Try not to think too far in the future. This will make the pain cave more manageable.
2. Focus on your environment. Avoid overthinking about your physical discomfort symptoms. Try focusing on the surroundings, such as the scenery, a running partner, the other race competitors or fans. I sometimes imagine myself enjoying a Sunday fun-run with friends, instead of enduring hours of a long ultra. This can help you mentally detach from the pain and push past it.
3. Listen to music. Or let a favorite song run through your head. While running the 100-km Biel ultramarathon, the song ‘Stressed Out’ by Twenty One Pilots (Album: Blurryface) ran through my head for 12 hours. I’m not a big fan of the song, but my daughter loved it at the time, so it made me think of her, and that kept me motivated.
4. Adopt a mantra. A mantra is a sound, word, or short phrase of unique significance, repeated over and over, to help with either concentration or going through pain and unpleasant situations. When you believe in yourself and have positive thoughts, you are more likely to perform at your best. “Push harder.” “Steady forward momentum.” “No pain. No gain.” Mantras have personal significance and thus what works for even the best elites, might not work for you. “The shortest distance between two points is a straight line”, repeated probably 1,000 times in my head, got me through a night of running in the Moroccan desert.
5. Listen to your body. It’s natural to feel uncomfortable when you physically challenge yourself. However, there’s a difference between discomfort and serious physical pain that may cause long-term damage. Stop if you have: chest pain, light-headedness, or sharp pain. This isn’t your body telling you it would rather be sitting on the couch, it is sending up alarm signals that need to be heard. In 2008, two runners died of exhaustion linked to hypothermia and oxygen deprivation when hit by a snow storm while taking part in the Zugspitz Extremberglauf, a 16-km race with a 2,100-meter climb up the highest mountain in Germany. Sometimes we can get into a tunnel and ignore everything except for our goal of reaching the finish line, but we have to be clear-headed enough to be aware of the signs of a life-threatening situation.
The belief which inspired the ASICS company name, ‘A sound mind in a sound body’, demonstrates the close links between physical exercise, mental equilibrium and the ability to enjoy life. And perhaps they are much more inter-dependent upon each other than we think.
So whether we are born with a high pain tolerance or not, there is still hope that we can train our bodies to bear those physical and mental lows of an ultramarathon which can increase our willingness to suffer enough to not only enjoy the high of the finish line, but also, and more importantly, the path that led us there.
(This article first appeared on the ASICS website on November 08, 2020: https://www.asics.com/de/de-de/frontrunner/articles/can-i-increase-my-pain-tolerance)
Sources
Pain Processing in Elite and High-Level Athletes Compared to Non-athletes. Frontiers in Psychology, 28 July 2020
Pain Is Inevitable But Suffering Is Optional: Relationship of Pain Coping Strategies to Performance in Multistage Ultramarathon Runners (2020) Wilderness & Environmental Medicine 31(1)23-30
Psychological Factors Associated With Ultramarathon Runners’ Supranormal Pain Tolerance: A Pilot Study (2018) The Journal of Pain 19(12)1406-1415
Six Minute Mile (2020) Can I Increase my Pain Tolerance? https://www.sixminutemile.com/
High Pain Tolerance: Causes, Influences, and How to Affect it. (2020) Medical News Todayhttps://www.medicalnewstoday.com/articles/high-pain-tolerance#raising-pain-tolerance
What is a “Pain Cave” and How Do You Power Through It in a Workout or Race? (2020) Health Online. https://www.healthline.com/health/fitness-exercise/pain-cave
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