Pain, Endurance and The Art of Suffering
Article by Tait Hearps of Sweat Elite
Athletes are a group of people who tend to have a unique relationship to pain. Often viewed from the outside as masochists, there is something about pushing through pain that pulls people back to their chosen outlets again and again. In researching for the conversation I recently had with Kilian Jornet, I spent a lot of time delving into the treasure trove that his site, Mountains and Athleticism, offers up for anyone interested in human-powered movement (especially movement up, around, across and over mountains). He summarised his relationship with pain beautifully with the following passage, which comes from his post entitled The Art of Suffering:
“If you don’t like pain, you can train hard for a week, a month or maybe a year, but you will not train a lifetime. The life of an elite athlete may seem idyllic; traveling around the world practicing an activity that we are passionate about, but the reality is closer to cold rainy mornings with some knee pain and an injury that begins to poke and makes you doubt of the continuity of your way of making a living. The life of the elite athlete is, in the end, the art of knowing how to suffer.”
As anyone who has pushed themselves to cover a certain distance as fast as they can would know, pain is inextricably linked to performing well in endurance sports. But how can our relationship to pain change, or be manipulated, to allow us to perform better? Or to feel less of it? Can we find a more artful way to suffer and yield better results in the process?
Alex Hutchinson does a deep dive into this topic in one of the chapters of his incredible book Endure, a tome of fascinating science, compelling anecdotes and timeless wisdom that requires a lot of highlighting and re-reading to fully digest. The chapter centres around the story of legendary German cyclist, Jens Voigt, and his world record in “The Hour”. Circling the velodrome and covering 51,110 metres, Voigt beat the previous record by almost a mile. The man renown for taking himself to dark places went further than ever before as he left a final mark before his retirement. “Everything was aching… I was really and truly in a world of pain.”
Voigt is famed for his willingness to suffer. The title of his autobiography, Shut Up, Legs! comes from his response to a journalist when asked how he manages to continue to push through such unbearable agony, despite mounting signals to stop. But is it an inborn ability to endure a level of suffering that would undoubtedly cause most to stop, that allows an elite athlete such as Voigt to reach the top of their field? Or is this something that can be trained and expanded, just as one’s strength and VO2 max can be propelled upwards with appropriate training.
Hutchinson examines the work of many preeminent experts in the field of sports science in order to look at these questions. The results are fascinating.
Importantly, the relationship between pain tolerance and performance is not so direct in skill sports such as tennis or soccer, but in endurance sports it is undeniable. Pain is also more multifaceted than it seems at first glance. According to Jeffrey Mogil, head of the Pain Genetics Lab at McGill University, “Pain is more than one thing. It’s a sensation, like vision or touch; it’s an emotion, like anger or sadness; and it’s also a “drive state” that compels action, like hunger. For athletes, the role of pain depends on how these different effects mingle together in their specific situation. Sometimes pain slows them to a halt; other times it drives them to even greater heights.”
One study that Hutchinson cites, highlighting how differently people can process the same painful stimulus, was published by Wolfgang Freund in 2013. Participants were asked to hold their hands in ice water for three minutes and rate the pain they felt as the trial concluded. A group of ultrarunners completed the protocol and their average pain rating was six out of ten. Contrast this with the non-athlete control group who averaged 96 seconds before removing their hands as their pain maxed out at 10. Only three of the control group lasted the full three minutes. It must be noted that the ultrarunners tested were running the gruelling TransEurope Footrace which covers 2,789 miles in 64 days: athletes with an especially insatiable appetite for suffering.
Similar findings came up in a study by Karel Gijsbers, looking at Scottish swimmers and their tolerance of pain. The test protocol involved inflating a blood pressure cuff around the subject’s arm to cease circulation to the limb, followed by repeated clenching of the fist once per second, for as long as the subject could bear. Thirty elite (national level) swimmers were compared with thirty club swimmers and a non-athlete control group. The implications of Gijsbers’ findings are enormous.
The results show that the pain threshold was very similar for the three groups, with most participants beginning to report painful sensations at around 50 contractions. Athletes are not insensitive and feel pain like everyone else. What sets them apart lies elsewhere: there were stark differences in the pain tolerance exhibited by the three groups. The control group averaged 70 contractions before throwing in the towel (only ~20 beyond when they started to feel pain), club-level swimmers averaged 89, and the elite averaged 132, almost double the control group!
Gijsbers went a step further and examined the tolerance of the elite swimmers at different points in their training cycles. He found pain tolerance to be highest during the swimmers’ peak racing period in June, and lowest following their off-season in October. Below is an excerpt from the article in the British Journal of Medicine.
The researchers concluded that “systematic exposure to periods of intense but limited pain,” can result in short-term adaptations to pain perception and tolerance. The fluctuations in tolerance suggest that the type of training an athlete is doing influences the extent to which they are able to endure pain.
Hutchinson zeroes in on this idea, citing data from a much more recent study conducted at Oxford Brookes University in Britain, to illustrate the point that pain tolerance is trainable and a crucial component of improved performance in endurance sports. Researchers used the same protocol (blood pressure cuff and fist clenching) as in the previous study to establish pain threshold and tolerance for two groups, and conducted these tests before and after a six-week training program in which participants did either medium-intensity continuous cycling (CONT), or high-intensity interval training (HIIT).
The training programs were matched for workload, and saw similar improvements in parameters of aerobic fitness, namely VO2 max and lactate threshold. However, the pain tolerance of HIIT group increased by 41%, whereas the CONT group saw no significant change in pain tolerance. The most telling results from this study are seen in the time to exhaustion (TTE) data (participants are made to cycle at a fixed high intensity until they can no longer maintain that power), which shows that the CONT group improved their TTE by a massive 38%… but this pales in comparison to the 148% increase seen in the HIIT group. This means that in a mere six weeks participants from the HIIT group were able to endure for more than twice as long as before the training! Hutchinson highlights here that “simply getting fitter doesn’t magically increase your pain tolerance; how you get fit matters: you have to suffer.” It is important to note that the subjects in these trials were ‘healthy adults’, not highly trained athletes, and so the large increases seen here are unlikely to be replicable in someone who has already been training for a long time.
So, let’s summarise the findings we have discussed here.
- Pain is complex and experienced differently by different people, but it’s inextricably linked to performance in endurance sports.
- Athletes and non-athletes tend to differ more so in their pain tolerance (how long they can endure painful stimuli) rather than their pain threshold (the point at which they start feeling pain).
- High level athletes tend to be able to endure pain for longer, and this varies depending on how they have been training.
- More painful training stimulus seems to increase pain tolerance to a greater degree than less painful training, leading to improved endurance results.
As Hutchinson puts it, this train of thought “leaves a ripe and juicy question dangling for future researchers: can you get faster simply by training yourself to better tolerate or block out pain?” He goes into a bunch more really interesting research on this topic, and I highly recommend exploring the entirety of his book. The findings from these studies suggest that the age-old “no pain, no gain” motto (which – side note – originated from the Hebrew text, Pirkei Avot 5:23 (The Ethics of the Fathers), “According to the pain is the gain,” as a spiritual lesson) holds more truth than some care to admit.
But it also must be emphasised that at this stage only exposure to specific types of pain have been shown to greatly improve endurance performance (independently of improvements in fitness), namely the pain that comes with high intensity interval training, which closely resembles the pain that comes into play during competition. As far as I am aware there is yet to be a comprehensive study on whether training yourself to endure pain by pulling out your fingernails or dropping weights on your toes will result in improved performance through improved pain tolerance, but stranger things have happened.
Whilst reading through all of this data the refrain repeated by the Kenyan athletes we spent time with in Kaptagat and Iten incessantly came to mind, “Train hard, win easy.” Not only does hard training improve physiological metrics that allow improved performance, but repeated exposure to the acutely uncomfortable sensations that come with high intensity intervals allow desensitisation to the sense of impending doom that may arise along with that set of sensations. Familiarisation with this pain can aid to translate it from a negative experience to what Gijsbers reports as “strangely satisfying to the highly motivated athlete.”
An important caveat to all of this talk about pain is that certain types of pain are very damaging and won’t help you improve performance. Pain is the way you process signals from the body that you should probably stop doing whatever you’re doing. For some of the causes of those signals it can be beneficial to push through (burning muscles during a hard interval set), but others should not be ignored as they can cause lasting damage. The deep ache of a developing stress fracture, the stabbing pain as you sprain ankle ligaments. Pushing through the pain of injuries is not generally productive and not something to be revered. It’s also important to note that often the anticipation of pain can be worse than the pain itself, so don’t overthink everything before a hard session or race.
Accepting that performing at your best is going to be inherently painful is a necessity, and coming to embrace the pain is going to remove a whole lot of resistance to getting the hard work done. As Kilian puts it, “I have read a lot of sports science books but I have never found a better advice for training and racing than the first rule in the Hardrock 100 endurance run regulations: No Whining.” Don’t shy away from pain, don’t complain about it, it’s part of the process of achieving the improvements you’re working hard for. Next time you’re hurting in a session, think of Zátopek’s famous quote: “When it hurts to go, go faster.” Embrace the pain, feel all of it, and focus on refining the art of suffering.
