Pain: A Matter of Perception for Endurance Athletes?

jlustick's picture
As a competitive long-distance runner, I have often debated the validity of athletic talent. While talent seems to play a key role in sports like soccer, basketball, and tennis which require a sophisticated level of hand-eye coordination, gracefulness, and spatial perception, it seems less critical to endurance sports. I’d like to suggest that pain tolerance is in fact the most important skill of endurance athletes. I believe that this tolerance depends upon an individual’s ability to process and experience physical sensations normally classified as pain as something else. Finally, I assert that pain tolerance can be learned and may affect arenas other than athletics.

To offer some background, pain is associated with the stimulation of nociceptors which can activate two pathways: reflexive response integration in the spinal cord and ascending pathways to the cerebral cortex that become conscious sensations. Nociceptive pain results from free nerve endings responding to chemical, mechanical, and thermal stimuli within ion channels. In the latter pathway, the limbic system and hypothalamus are also involved, causing physical pain to be accompanied by emotional distress and a range of autonomic responses, like nausea, sweating, or increased heart rate. (1)

There are three general types of pain, emotional and injury-related being the ones with which people are most familiar. It is the third form, however, that which is a result of an intense, prolonged, energy-expending effort, which is at the crux of endurance sports. Such discomfort derives from an elevated heart rate, exhaustion of respiratory muscles, buildup of lactic acid in skeletal muscles, dehydration, and depletion of muscle glycogen from body stores (2). Nonetheless, millions of individuals engage in such sports and experience such pain on a daily basis.

On the other hand, perhaps what endurance athletes feel is not pain. Perhaps pain is a concept that exists in one’s mind and athletes possess the mental faculty to process these physical sensations as something far more positive than pain. After all pain is not a stimulus or input but a perceived sensation (1).

The word “pain” has a strong negative connotation, often referring to an intense level of bodily and/or mental suffering. By definition, “pain” interferes with our standard physical and/or psychological way of being; it is undesirable, unpleasant, and unproductive.  But these connotations are largely a result of emotional and injury-related pain and may not account for the productive pain that endurance athletes experience.

For runners, the burn of lungs and muscles serves as an index to their effort and success. Pain is an inherent and necessary part of endurance sports and to avoid it is to perform below one’s ability. To succeed is to be in pain and to be in pain is to succeed.

However, if pain is so normal, so positive, so desirable, is it still pain? Perhaps the feeling of pain depends upon a conception, a characterization of a physical sensation as abnormal and problematic. This notion is supported by the finding that people experience greater pain intensity when “catastrophizing” their condition. In a study on ballet dancers, Paperizos et al. defined “catastrophizing” as a combination of rumination, magnification, and helplessness, all of which serve to exacerbate the negativity of the pain (3). In contrast, endurance athletes do not catastrophize the pain they feel during performance (they may catastrophize injury-related pain) and, as a result, may experience it at a very low intensity or not at all. To use myself as an example, let’s say that I am sitting peacefully in a chair when my chest and lungs begin to burn. While this may be heartburn, it is not unlikely that I will begin to catastrophize (especially given my slight neuroticism), becoming worried about life-threatening cardiac and respiratory problems. If, on the other hand, I feel these same sensations while running, I will simply push forward, proud of my body’s ability to work so hard. In other words, athletes may not construe their bodily experiences as pain in the way that an observer might.

Deconstructing pain is not something that necessarily comes easily to athletes. Rather, as seen in a study released in December of 2007 by researchers Jeffrey Kress and Traci Statler, such individuals employ a complex assortment of cognitive strategies. They found that endurance athletes believe pain intensity is purely a perception, and so pain control is simply a form of mind control. These athletes support the “mind over matter” phenomenon which many individuals suffering from chronic pain reject. The former Olympic cyclists that Kress and Statler interviewed understand pain as a positive experience that affirms their identity, success, and dedication. For them, pain connotes a development rather than breakdown of the self. Pain also diminishes as endurance athletes focus on their satisfaction, the rewards for tolerating this physical state, and the finite quality of their discomfort. Furthermore, occupying a position of control translates into pain control. This suggests that “pain” may be at least partially due to a loss of command over one’s physical self and sense of being at the mercy of something or someone else. These cyclists, like many other endurance athletes, report the use of imagery and positive self-talk before and during competition to combat and prepare for the pain (2). Such processes result in the normalization of their physical state so that it is no longer “pain.”

Most athletes, myself included, would probably agree that it is far easier to handle pain during competition than during training requiring an equivalent or slightly lower level of exertion. In fact, many athletes find that when competing, as when in other high-stress situations, they are able to perform at a higher level than they would have imagined possible. There are several explanations for this disparity. First, the stress of competition typically causes the release of adrenaline (epinephrine), which is responsible for the body’s fight and flight response. Epinephrine increases the flow of oxygen to the brain and muscles, making it easier for the body to function at and sustain a high level of exertion. Adrenaline can be thought of as a kind of defense mechanism that helps a person escape from a precarious situation. Epinephrine also aids in the suppression of temporarily unnecessary bodily activities like the immune and digestive systems, leaving more energy available for the chief activity.  Strenuous exercise also triggers the release of endorphins into the bloodstream. Endorphins are morphine-like compounds produced by the pituitary gland and hypothalamus that serve as natural pain relievers. Like opiates, endorphins block pain perception by decreasing neurotransmitter release from primary sensory neurons and inhibiting secondary sensory neurons (1). Furthermore, the mental demands of competition serve as distractions; athletes may be so mentally preoccupied with strategy, pushing forward, and staying focused, among other things, that there may not be sufficient attentional resources for them to feel pain as well (4). Finally, the positive rewards that accompany racing may prevent individuals such physical sensations as “pain.” (2, 5)

Pain makes every endurance athlete her own worst enemy. The internal battle, a fight against the experience of pain and the body’s reluctance to enter a state of discomfort, is by far the most grueling competition. An athlete must conquer her own body and mind before she can take on those of others. When faced with fatigue and severe muscle, joint, and respiratory pain, she must emphatically reject her body’s orders to stop and instead push harder. With each fight, an athlete slowly but steadily retrains her mind and body.

The common purpose of pain is to connect body to mind, alerting the latter of problems in the former. Pain can be thought of as a physical manifestation of a “Stop” command. Nociceptors, activated by pain, initiate protective responses such as pulling one’s hand away from a hot iron (1). Generally, the discomfort and even intolerability of pain elicits a response that serves as a form of relief. Seemingly, endurance athletes train themselves to override the stop command or, given the positive processing of these physical sensations, never experience such a directive. The body is known to suppress pain during emergency situations when one’s survival is in jeopardy. Under such conditions, descending pathways travel through the thalamus and inhibit nociceptor neurons in the spinal cord (1).

However, ignoring this stop command could have grave consequences. Much injury-related pain, like that associated with strained muscles or tendonitis, feels similar to endurance pain, and, from personal experience, it is easy to confuse to the two. Athletes may respond to injury-related pain less intensely or even ignore it, allowing it to develop into an acute injury that could have been prevented. Stress fractures, muscle strain, tendonitis, and arthritis are among the many injuries common to endurance athletes, and all of them are largely a result of over-training or neglecting to “stop.”

Seemingly, the best athletes can titrate their pain tolerance, increasing it during competition and training and decreasing it during all other times, when it is important to be attuned to lingering soreness and pangs which may be indicative of injury. Unfortunately, many endurance athletes accept pain as something that’s destined to plague them not just during exercise, but during daily life as well. These are individuals whose careers tend to be ruined by serious, debilitating injuries, which, when neglected, can be unrelenting.

My final question has to do with emotional pain tolerance and whether endurance athletes are also more psychologically resilient. It seems natural to conclude that these individuals might have greater frustration tolerance and will power, both of which are valuable when coping with emotional pain. Therefore, perhaps both physical and emotional pain tolerance can be learned through participation in endurance sports. So go ahead, sign your kids up for swim team, soccer, and ballet and help them acquire these valuable life skills in addition to physical fitness.



Works Cited

1) Silverthorn D. Human Physiology: An Integrated Approach, 4th ed. San Francisco: Pearson’s Education, Inc., 2007.

2) Kress, J, Statler T. A naturalistic investigation of former Olympic cyclists’ cognitive strategies for coping with exertion pain during performance. Journal of Sport Behavior. Dec. 2007 (30.4): 428-452.

3) Paparizos, A, Tripp D, Sullivan M, Rubenstein M. Catastrophizing and pain perception in recreational ballet dancers. Journal of Sport Behavior; Mar. 2005 (28.1): 35-50.

4) Unrod, M. Kassel J, Robinson M. Effects of smoking, distraction, and gender on pain perception. Behavioral Medicine; fall 2004 (30): 133-139.

5) Bentley, T. 1987 May 31. Dancers: the agony and the ecstasy. The New York Times. Available at: www.nytimes.com Accessed: 2009 April 14.

Comments

Chin's picture

I agree with your post

I agree with your post absolutely and I am now interested in reading some more of your posts on your blog and see what you have to say. I just bookmarked this one and do you mind if I tweet your blog post out to my followers on twitter? I think they would also enjoy the blog post. I also wrote an article on my blog about tendonitis treatment please check it out.

Thanks.
Chin

Paul Grobstein's picture

endurance athletes and pain

"endurance athletes train themselves to override the stop command or, given the positive processing of these physical sensations, never experience such a directive."

Or perhaps both?  It isn't, afterall the experience of pain that causes one to pull one's hand away from a flame; that occurs before one is aware of pain.  So one certainly needs to override the "stop" command that the cognitive unconscious would normally issue, AND  experience whatever signals one gets from the cognitive unconscious as something other than "pain"?

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