You don’t have to be a top pro to experience pain when you’re out on your bike or going for a run. Joining in the local group ride can be torture when you hit that 30-second climb, or even just hitting a steep climb while out by yourself can certainly activate your nociceptors, your body’s pain receptors.
So why do we do this? Well, the reward of cresting the local climb or the excitement of being in the lead group can make it all worth it. Plus, often what we’re really talking about is discomfort, not pain. And the fact is, if we’re going to adapt and get stronger, discomfort is a necessity. Perhaps it’s less about “no pain, no gain” and more about “no stress, no adaptation.”
So, in this episode, we jump into the pain cave to find out more about this fascinating topic. And, to be clear, we’re not talking about the pain associated with injury, but rather the everyday pain or discomfort of training and pushing our limits. We pose the questions: What is pain? What are the different types of pain and how do we tolerate it? We have receptors to tell us when we’re in pain, but it’s our brains that interpret those signals, so our perception has a big influence on how we experience pain and discomfort. Fortunately, we have the ability to both train and alter that perception. While we can’t just make pain go away, we can make it more manageable.
Joining us for this episode is neuroscientist Dr. Scott Frey, Professor Emeritus of Psychological Sciences at the University of Missouri, and frequent Fast Talk podcast co-host Grant Holicky. Dr Frey now has his own business, Neurocognitive Consulting, that helps both individuals and groups seeking science-based solutions for performance enhancement, including pain tolerance.
Along with Dr. Frey, we’ll hear from Dr. Inigo Mujika, renowned physiologist and coach, fellow podcaster and professional mountain biker Sonya Looney, Dr. Robert Kenefick, a researcher at the U.S. Army Research Institute of Environmental Medicine, legendary coach Joe Friel, and Ultraman world champion Dede Griesbauer.
So, put on your best pain face and let’s make you fast!
Rob Pickels 00:04
Hello and welcome to Fast Talk, your source for the science of endurance performance. I’m your host Rob Pickels here with coaches Trevor Connor and Grant Holicky. You felt the torture of all out efforts on shirt hills and the similar yet different aches you feel after racking up the hours. So why do we do this? Today we’re talking about pain, but not to glorify it like the “no pain, no gain” mantra. The simple fact is that without stress, there is no adaptation. There can’t be stress without some discomfort. Us endurance athletes, we’re an odd bunch. In this episode, we’re focused on the everyday discomfort of training and racing, not injuries. We’ll talk about different types of pain, pain tolerance, and perception and how training can influence it all. No, we can’t just make your pain go away, but we can make it a bit more manageable. Dr. Scott Frey who is previously discussing the mind body connection with us is making his return to our show. Dr. Frey is Professor Emeritus of Psychological Science at University of Missouri as well as a consultant for individuals and groups with his own company, Neurocognitive Consulting. Along with Dr. Frey we’ll hear from renowned coaches Joe Friel and Dr. Inigo Mujika. Athletes Sonya Looney and Dede Griesbauer, and researcher at the US Army Research Institute of Environmental Medicine, Dr. Robert Kenefick. So put on your best pain face, and let’s make you fast.
Ryan Kohler 01:33
Hey, listeners, this is expert coach and physiologist Ryan Kohler from Rocky Mountain Devo and we just launched the Fast Talk Labs six weeks strength training series. As many of you know, building and maintaining muscle strength is a crucial component of your training program. Whether you’re a cyclist, runner, triathlete, adventurer, or recreational athlete, we’ll be releasing an easy to follow workout every week that will help you get stronger and more durable for your chosen sport. Don’t let your strength slide this upcoming season. Check out more at fasttalklabs.com.
Trevor Connor 02:05
Well welcome everybody to the show. This is in some ways, a part two episode do we say Rob
Rob Pickels 02:11
Yeah, back in what 233 we did a mind-body connection-I forget the actual title-but now we have Scott Frey back on the show again.
Trevor Connor 02:19
Yeah and Scott, we had originally planned in that episode to talk about dealing with pain. And after we were an hour into the episode, and only halfway through the outline, we went, “Ah, we need to do a second episode.” So this is that second episode, we are going to do a dedicated show on Sunday. That’s actually if you’re an endurance athlete, and even if you’re just going and doing your first Gran Fondo, this is something that you’re going to be dealing with, which is pain. So hopefully we can tell you a little bit about what’s going on when you’re feeling that pain and give you some strategies on how to manage it. So Scott, welcome to the show.
Scott Frey 02:55
Yeah, thanks for having me back. I’m glad that we have the opportunity to talk about everybody’s favorite topic…pain.
Trevor Connor 03:01
So give us a little bit, the two minutes on your background and why you are the person to talk to about this.
Scott Frey 03:07
Yeah, well, I’m a cognitive neuroscientist, which means that I’m basically spent the last 30 years, most of my adulthood, studying how the brain creates our behavior. And the reason that that’s pertinent to our topic today is that pain is in fact, a perception. You might think that pain is coming at you from the outside world, and so forth. But in fact, pain is a creation of your brain, like all of our perceptions. And I suppose we’re going to get into that. And I think that fact is actually really important and actionable information for athletes who are having to deal with effort related pain in order to get the most out of themselves.
Topic of Pain
Rob Pickels 03:44
So this is a topic that I have kind of struggled with because I think that there is an over glorification of pain in endurance sports, in sports in general, but especially in cycling. And this was almost one that I didn’t want to touch with a 10 foot pole because of all those gritty images of people like gritting their teeth and suffering. And, “Oh, this sport is only fun if you’re suffering,” is a message that really gets out there. And I do think in the past couple years there has been a shift towards “Riding bikes is fun, let’s go out and have fun.” But as I began looking into the outline and working with Scott to create the outline for this, the topic of pain is so deep and so complex. And no matter what, no matter how you’re approaching the sport, even if you are out to have fun and high fives with your friends, discomfort comes into the ride in so many ways and we don’t have to over glorify it, but we do have to say, “Hey, this is a part of everything that we’re doing.” It affects physically, emotionally, mentally, what’s happening during the ride. So I’m actually pretty interested in this topic now.
Trevor Connor 04:54
This is where I really have to lean into myself and say, Is there such a thing as fun without pain?
Rob Pickels 04:58
Grant Holicky 04:59
Well, but I think that’s an interesting topic anyway because I can’t tell you how many people I know that ride and have riden and then decide at some point, “Well, I’m not going to race anymore. It’s taken away from the fun.” But then they go out and they do these group rides and these group rides, they’re just killing themselves. They’re just absolutely going full gas, and then stopping and eating and pastry, and then going full gas again. And those are the rides I hate because I want to go do my training, and then I’ll go race and be in pain. But I just want to go train and do the things that I need to do very methodically.
Scott Frey 05:34
Yeah, I think it’s an interesting point. And with the boom of indoor racing, that is the pain cave from the first 30 seconds onward, right?
Grant Holicky 05:43
We were talking about that this morning, yeah.
Trevor Connor 05:45
Yeah, I did a Zwift ride yesterday that just had me annoyed the whole time. Because every time we hit a little hill, 600 watts.
Rob Pickels 05:53
I did five hours in foggy 30 degree weather so I was feeling pain too. You don’t have to just be in the pain cave so.
Scott Frey 05:59
Yeah, there are many different types of pain, right? We have a lot of descriptions for pain and that’s one of the things we might get into today. There’s the kind of nawing, slow pain that accumulates over those four hour cold rides like you did. There’s that searing, burning pain of you know, I’m two minutes into this Zwift ride and these other people are fresh because somebody’s always fresh on Zwift.
Trevor Connor 06:24
As a coach and exercise physiologist, Dr. Inigo Mujika, is very familiar with the different types of pain that athletes put themselves through. He talked with us about how everyone defines it differently.
How Pain is Defined
Dr. Iñigo Mujika 06:35
Pain is very subjective. And it probably depends on previous experiences of pain. And therefore, people are going to be able to cope with different levels of pain, probably based on what they have experienced before. So if you have an objective level of pain, and you show that level of pain to someone who has suffered burns, in 60% of their body, they’re going to say, “This is not pain, this is just a little discomfort.” If you show that level of pain to someone who has never suffered any painful experience in their life, they are going to say, This is unbearable. This is the highest level of pain that a human being could ever experience. So I think pain is a rather subjective feeling and rather subjective experience. And therefore athletes are going to be able to cope with different levels of pain differently, and probably in relation to their previous experiences. I think is a signal of discomfort that is found not by your muscles, or by your skin, or by your bones, it is felt by your brain. And it’s just different levels of discomfort.
Trevor Connor 07:58
So that’s kind of a good segue. I think there’s three terms that we need to define here, because we’re probably going to talk about them a lot. One is pain threshold. Another one is pain tolerance. And the third one is pain severity. So Scott, do you want to give us the quick definition of each?
Scott Frey 08:14
Yeah, so from the perspective of someone working in my field, pain threshold is the point where a sensory experience that you’re having. Let’s take cold, for example. A lot of the studies we do in the lab, we might expose people to cold. They stick their arm in a bucket of ice water, for example, how long can they hold that arm in there, right? It would be the kind of test and there’s a point at which your arm goes from being cold to being painful. And physiologically, that’s a really important threshold because the sensory receptors that are being stimulated, in your hands say, are changing at that point. They’re changing from the normal thermal receptors that let you tell, you know, this is a warm cup of coffee or a cold glass of beer or whatever it is to nociceptors, which are specialized neurons that sense pain. And they also have this anticipatory quality to them, which will be important for our discussion later I think. Pain intensity is an entirely subjective rating that somebody would give you. We don’t have a blood test for pain. We don’t have a brain scan for pain. There’s no objective way to evaluate somebody’s pain. The tool that we have is the same one you get in the doctor’s office when you go in with an injury, right? The little smiley to sad to frowning to desperate faces. That’s it. That’s the state of the art and measuring pain intensity, and then,
Trevor Connor 09:40
Scott Frey 09:41
Yeah, pain tolerance is an interesting one. And it’s something that athletes, particularly endurance athletes, and interestingly, not so much strength athletes, at least according to the literature, have an elevation of. We have better pain tolerance, but we still have the same level of perception of pain intensity.
Trevor Connor 10:03
So going back to that example of putting your arm and water pain tolerances, how long you can hold it in there before you just say enough?
Scott Frey 10:10
That’s right. And people very gingerly reach that point. They yank their arm out of the water. And we can time how long that takes. Pretty simple tests, but pretty effective.
Rob Pickels 10:20
Scott, something you said earlier really resonated with me. And that is that pain is about perception. Can you dive into that a little bit deeper for me?
Scott Frey 10:28
Yeah, and I think it relates to the point we were just discussing about pain intensity, right? You and I can be exposed to the exact same sensory stimulus, that cold water, I’ll keep coming back to that because it’s easy to discuss. We can get our digital thermometer, we can measure how cold that water is, we can time exactly how long you can tolerate holding your hand in there. But we don’t have any kind of objective tests like we would with a thermometer right or time for your level of perception of the intensity of that pain. And that’s the interesting part that really gets into the psychology. And I think that’s where we see differences in athletes. Their perceived intensity of the pain, how long they can tolerate it, those things seem to be malleable through our experience. Through that repeated, putting yourself in the pain cave, right? Having experiences with that, realizing that you can get out of there, right? And that things are going to be okay. It does seem to have a real training effect,
Rob Pickels 11:27
Right and so all of this pain perception, it’s happening in the brain.
Scott Frey 11:31
It’s all happening in the brain, just like all of our perceptions, you know? The sound of your voice, the the look of this room, and so forth. Those are all being created in our brain. It’s a hard thing to think about because the one thing we never doubt is our conscious experience, right?
Rob Pickels 11:47
Yeah no, it certainly is. And I cut my finger, there’s pain associated with that, right? And that’s a perception that happens in my mind. But it’s just sort of interesting to think about how the injury to my finger is not necessarily say directly affecting or directly causing, there are so many systems that are interacting between my finger in my brain, each one of those is able to modify that perception that I’m having. And it makes me think back in preparing for this. You know, you watch little mama dogs play with their little puppies and sometimes that play is quite rough, you know? And you’ll see them sort of bite. And ultimately it as far as I understand a desensitizing, or maybe a normalizing of some pain perceptions to say, “Hey, this is okay.” Do we see that culturally? Do we see that throughout our lives more? I’m thinking broader than just an athlete but.
Scott Frey 12:41
Yeah, for pain perception context is absolutely everything. One of the important things that pain researchers have discovered over the years is that pain isn’t really about damage to your body, right? A lot of the pain that we experience is anticipatory, or predictive. It’s trying to prevent us or give us an early warning signal to stop whatever you’re doing, in order to ward off pain. And so those nociceptors that I was saying kick in, when you have a painful experience, they also have an anticipatory quality to them. They’re not only sending information up to the brain, but the brain is sending information down to them to tune their sensitivity. And that’s where the role of context. The brain is perceiving the context you’re in. Do you feel safe? Do you feel comfortable? Have you been there before? And modulating your perception of an ability to tolerate that pain based on that
Rob Pickels 13:38
This is an area too we talk a lot about high intensity intervals of time at VO2 max all of these types of workouts. And we oftentimes can see drastic improvement relatively quickly from the highest intensity. And you have to wonder, and I guess all of this is physiological, how much of that has to do with better aerobic energy production? And how much is just tolerating the discomfort of going that hard?
Scott Frey 14:04
Yeah, well, I would say that a lot of the improvements that we see ,especially rapid improvements, probably have a lot to do with our getting comfortable, and not catastrophizing that high level of discomfort that comes with something like Trevor’s favorite five by five minute intervals, they’re miserable. But we can learn that we’re actually going to be okay, we can create that mental context of safety, and derive a bit of comfort and ease being in that place with practice. I think that’s an important part of what training does for us.
Trevor Connor 14:40
I think this is really important, particularly to athletes that are relatively new to training because as you said, the pain is anticipatory. So it’s trying to prevent you from doing damage. If your body is unfamiliar with the sort of work that you’re doing, or let’s say you’re jumping into your first race, it’s going to be over-protective because it doesn’t know how much it can handle. And this is something that you see a lot of athletes talk about as they hit higher and higher levels, that the sort of pain that they used to not be able to tolerate now becomes very tolerable. And they’re actually able to push much, much harder. As the body learns, yeah, I can actually cross this line and not do any damage. So I’ve talked to athletes about that a lot is that you learn there is a line. And initially, you can’t cross it eventually, you learned, yeah, it’s actually fairly easy to cross this line and there isn’t a lot of damage. Then the second thing you learn is there’s another line. And that’s the line if you cross that you are doing damage.
Scott Frey 15:36
Yeah and I think that’s a very important point to make clear, right at the outset. This conversation as we’ve kind of set it up is about the pain that accompanies effort. It’s not about the pain of an injury. And it’s really critical that athletes be able to differentiate those two things, because the pain that accompanies effort stops when you stop. The pain that accompanies injury tends not to. And we have to be really tuned into that, in order to avoid damaging ourselves.
Grant Holicky 16:08
My big observation with so much of this stuff, we’re talking about perception, and we’re talking about how different people perceive pain in different ways. We perceive our own pain differently in different times and in different moments. You know that you could break an ankle. If I break an ankle, when I’m hanging out with my kids, I’m going to experience more pain than I did when I broke my ankle playing soccer and continued to play on it for another 30 minutes. Or breaking my collarbone right before I had to pick up my kid from daycare is different than how I broke my collarbone when I was in a mid race and I kept racing, right? Those individual perceptions are going to be very different.
Trevor Connor 16:50
Yeah and for anybody who’s interested, we actually have a really good article, fairly new article on the website called “What’s the difference between good pain and bad pain?” written by a Carol Pastorelli–we’ll put the link to this in the show notes. But this is one from a physical therapist who’s talking about this difference between “This is injury pain, don’t push through it,” versus “This is training pain and it’s a good thing.”
Scott Frey 17:12
Yeah, and I think Grant’s point is really important. Again, it’s a good opportunity to reiterate one of the major themes here, which is that pain is not necessarily about tissue damage, your perception of pain, the intensity of the pain that you’re experiencing is really about a lot of psychological factors. The context you’re in, you’ve hurt before in soccer games, you’ve probably not hurt in the same way playing with your kids when you busted your ankle. There’s a great often referenced medical study that was published and it was about a construction worker who at the end of the day jumped off the platform that he was working on, landed on a big spike, it went right through his boot. Writhing in pain, rolling on the ground. They take him to the emergency room and anytime they tried to touch the boot, the guy is screaming, they dose him up with the best pain narcotics they have and they they carefully cut the boot off. And what they find is the nail passed right between his toes, there was no damage whatsoever. And yet, I would argue his pain was very, very real.
Grant Holicky 18:17
It was very real, yeah.
Scott Frey 18:18
We don’t need tissue damage to experience pain. And sometimes we can have profound amounts of tissue damage and not experience pain. There have been amazing studies looking at people, for example, in the context of war. Which is your soccer game might have been a little bit of an analogous situation, right? Any kind of physical activity competitive, you’re in a very different place. Well, war takes it, of course, to a very different level. But looking at the self-reported pain of injuries versus match control civilians who were experienced these injuries outside the context and camaraderie of war, the individuals injured in war feel very much less pain in those instances. And that’s been known for, you know, probably the last 60 years that study was done.
Rob Pickels 19:04
Pain’s your friend. There’s a very rare condition, genetic condition, where kids are born congenitally with the inability to feel pain and it’s a really difficult life for them. Lots of in juries and so forth. And let’s take this to the opposite end of the spectrum. For example, I know a guy who is a paraplegic, and he was also a ski racer. So he raced in a sit ski and crashed his sit ski. Unfortunately, broke his leg, didn’t know about it, pushed himself back up, continued the run, race the rest of the day, and then later had this general feeling of not being well. A malaise, a fatigue, didn’t quite understand what was going on. Turned out ended up at the doctor at the hospital, lo and behold his femur’s broken. Had absolutely no clue whatsoever. And I know that we all dream about never feeling. How good would it be if you never felt pain, but I suspect that’s not a good thing.
Trevor Connor 20:00
I mean, most of them don’t live past their 30s.
Multiple Elements of Pain
Scott Frey 20:03
Yes, that’s right. Pain’s your friend. Pain is there to really give you information to help you to avoid situations in which you’re going to damage yourself. And that’s another theme that I think we want to really emphasize. Pain has this predictive and protective element to it. It’s not simply about tissue damage.
Trevor Connor 20:22
So I just want to quickly go back to something that we touched on a little bit before that there’s multiple elements that play into pain, and they’re all real elements. So we talked about the pain sensors, or the nociceptors–I can never pronounce that.
Scott Frey 20:34
Trevor Connor 20:35
And those are very real. They’re designed to pick up on pain signals. But there is a psychological component. And I know as soon as I say that, you go “Oh well, pain’s in your head.” Well, yes and no. Yes, it is psychological. There is an emotional or psycho biological side to it. But that doesn’t mean that it’s not real. And the two interact with another. So can we talk a little bit about that?
Grant Holicky 20:59
Yeah I think one of the really important pieces to note, and this is coming from sports psychology side of things, is the understanding of that person’s pain is real. They’re experiencing something real. My my uncle passed away recently as a quadriplegic, and he was a 77-year-old quad, and he would get ghost pain, you know? Limb pain from something he hasn’t felt. But that pain was excruciating. And that pain is very, very real for him in that moment. And we have to understand the same thing for an athlete. We can’t look at an athlete and say, “It’s all in your head.” Because what they’re experiencing, they’re experiencing very acutely, and very truly, whether it’s created from a cut in their arm, or it’s created in the mind, it’s very real, and we have to treat it as such
Scott Frey 21:50
Yeah, absolutely Grant. I think the point you make is a really good one. A lot of the work that I’ve done in the lab over the last 15 plus years has been with people who’ve lost limbs. And a profound example of exactly what you’re talking about. They experience very often what we call Phantom Pain, right? Pain in a limb they no longer have, and it is one of the most medically difficult pains to treat. It is happening because it’s being generated centrally in the brain. There is no limb to have the pain coming from and yet it can be disabling for people. So yeah, it really is the takeaway message I think for our audience is that pain is being created in your mind, which is exactly true of all of your other perceptions. And none of us can really get into the head of one another. And so as a coach, when you’re working with athletes, and you’re listening to what they’re saying about their pain, you have to be really careful not to dismiss the feedback that you’re getting when you’re deciding whether you can push that athlete a little more, which might be appropriate, or whether you need to back it off a little bit. My favorite example of this is, and and Rob will laugh at this, but we talk about cyclocross and we talk about back pain and cyclocross. And there’s this old expression that your back always hurts when you race cross. It’s just whether you’re racing well or you’re racing poorly as to how much it hurts. But that is triggered by something else. And that’s another way for a coach or a men’s performance coach to angle at that and say, “Okay, well, we’re having a bad race and the back pain showed up. Let’s talk about some other things.” Maybe too, because we want to be able to push through that pain, but we want to know some of what’s generating that pain and why. Yeah, absolutely. And if we look to the physiology of pain, it supports all that we’re saying with hard physiological evidence and anatomical evidence. There are two systems in your brain, one that processes the input from these nociceptors that are detecting pain, a sensory level, and another which is tied into the emotional systems within the higher levels of your brain that are involved in creating that perception. How do you feel about that pain?
Grant Holicky 24:06
I think that’s a wonderful point that it’s tied into the emotional system of the brain. And this is another thing that we need to understand. I can’t tell you how many athletes have come out of a bad race and say “It just hurt. It hurts so bad.” And then if you ask them how they felt during the good race, “It felt amazing.” And the reality is, there’s a similar amount of receptor pain being created. It’s just how emotionally you process that after the fact or in the moment. Hey, if you’re winning man, great. It drives you.
Trevor Connor 24:39
One of the best examples I can think of with that, I’m a breakaway rider. If I’m off the front, and I know I have to put out 350 watts to stay away, I can suffer through that pain. And I can make that happen. If I’m off the back, let’s say mechanical or whatever, and I know I have to put out 350 watts to catch the field. I can’t
Grant Holicky 24:58
It’s totally different.
Trevor Connor 24:59
It hurts too much when you’re off the back.
Grant Holicky 25:02
Absolutely. And there’s some great studies that talk about, especially climbing, the benefit of riding behind a teammate, that it’s not drafting. There’s no drafting going on at that point. But riding behind a teammate who’s setting the pace has this huge benefit. But at the same time, there’s also studies that talk about riding behind a competitor and if that competitor is setting the pace, that pace is uncomfortable, almost immediately. Whether it’s hard or easy or whatever because it’s not your pace. You’re not the one defining what’s going on.
Trevor Connor 25:36
Whenever I’m in a race and we’re on a climb, if I’m not having a great day, I want to lead up that climb for exactly that reason, because there’s that mental thing of, “Well, this can’t be that bad, because I’m on the front.”
Scott Frey 25:47
Right, psychologists talk about locus of control, right? Who’s driving the bus? And I think for most of us, when we’re uncomfortable, we would like to really think that we’re the ones who have control over that. Cycling is kind of unique in the sense that we benefit so much from the draft, that staying on someone’s wheel, who’s really trying to get rid of us, competing against us, is really advantageous. Yet, when you do that, you’re kind of surrendering control over the amount of pain that you’re going to be experiencing. And learning to tolerate that and not freak out is a big part of becoming better rider.
Trevor Connor 26:22
I can’t remember the exact quote, but still, my favorite Jens Voigt quote is not the “Shut up legs.” It was a quote where he said, “When I’m on the front, it really hurts. But I don’t mind because I know everybody behind me is hurting more.”
Scott Frey 26:35
Yeah I think that’s good. One of the things that I’ve tried to think about in the years and of doing various endurance sports was that I’m hurting really bad. But if the people around me are still with me, and not ahead of me, they must be hurting at least as much as I am.
Trevor Connor 26:50
Let’s hear from Sandra Looney about the ways that she has learned to control pain.
Ways to Control Pain
Sonya Looney 26:54
I think I’m somebody that has a high pain tolerance, but that comes with an acceptance of the pain. And I noticed that if I am in the quote, “pain cave,” and instead of being separate from the pain, I say to myself, “I am the pain.” And I welcome the pain in, then I’m able to push a little bit harder. Because I think whenever you are trying to separate yourself from it, or you’re sounding an alarm bell because it hurts, well, then it’s going to be a little bit harder to stay in it for longer.
Trevor Connor 27:18
Did you always have a high pain tolerance? Or is that learned? Are these skills that you’ve developed?
Sonya Looney 27:23
I think some of it is learned, some of it is innate. But I think also the self talk that comes around the pain and what’s happening and why can really help build that pain tolerance.
Trevor Connor 27:33
So you just talked about one, which is just accepting the pain. Are there any other tactics you’d give athletes to learn how to handle pain.
Sonya Looney 27:40
By using self talk in the third person or using your name can be really effective. Saying, “You got this or keep going, Trevor.” Using that motivational type of self talk using your name can really help you push through that painful period.
Rob Pickels 27:53
Let’s keep this conversation going with the pain and the athletic performance side. Because as we’re talking about the things that we’re feeling, the pain sensations, our perceptions of it, that is going into regulating our performance when we’re on the road or on the trail wherever we are.
Scott Frey 28:09
Yeah, absolutely. It’s a kind of a governor on our performance to some degree. I had a friend who was a very high level swimmer. And I remember talking to him as I was trying to improve my swimming some decades ago. Does it get to the point where you feel less pain? And he said, “No, you just go fast.”
Trevor Connor 28:25
You just become okay with the pain. On this performance side, something I found very interesting, and you sent us several studies to look at. One was pain processing in elite and high level athletes compared to non athletes. And the other one was athlete’s inclination to play through pain, a coping perspective. And both of them had one thing in common. One talked about fear of pain, the other one talked about and let’s see if I can pronounce this catastrophizing pain. And both basically said, if you have a higher fear of pain, or if you see it as catastrophic, your ability to tolerate pain goes down and your experience of pain becomes worse, which I found really interesting. That goes back to the psychological side.
Scott Frey 29:13
Yeah, I mean, think about that person who is having the perception that that big steel spike was through their toes, right? And they were catastrophizing like crazy and writhing in pain as a result of that.
Approaching Pain Before a Race
Grant Holicky 29:24
And this is where we have to approach those things way before the event starts in that person’s perception and what they think that event is going to be about. I’ve found in a lot of the work that I’ve done with athletes that when we’re very results based, when we’re very much about what that result is going to be, any amount of pain that creeps in, we start worrying about that result. That’s when we start getting to that place of like, “Oh no, I feel pain, we’re in trouble.” Whereas if it’s process based and the goal is to go in there and to do this race plan or perform this way, we’re almost just assuming the pain is going to be part of that performance. A lot of times when we look at it and say, “I’m going to go win this, it’s going to be no problem,” that’s the most dangerous thing an athlete can say, then that pain creeps in, because you’re gonna feel it, you’re going hard. And as we mentioned before your body’s screaming, “Whoa, man, don’t do this. You keep going down this road, we’re gonna be in trouble.”
Rob Pickels 30:23
Grant, I think that you bringing up this process needs to be occurring before it matters for the actual performance. Because a lot of what I’m hearing, right pain is in the mind, pain can be affected by what we’re used to, and what we’ve been accustomed to, we ultimately have some control–some I’m sure not all control over how we’re perceiving how we’re judging the pain–the value that we’re placing on it. But we can’t expect an athlete to make this leap to have this revelation in the middle of battle, so to say, and that’s where as a coach in general, or as a mental performance coach, to be working toward these changes for months, weeks ahead of time, so that hopefully the thinking is in place prior to when it matters on that final climb. Then that’s how we set people up for success.
Grant Holicky 31:16
Well and I think that, you know, I have a friend who will say “Pain is a choice.” And they’ve said to me, “Well, it is, isn’t it?” And I’m like, “It depends,” right? Like, when are you making that choice? In the throes of an event, you’re not making that choice?
Scott Frey 31:32
Yeah, pain is not optional if we’re going to get the most out of ourselves. It’s the reality. In fact, if I was outracing and I wasn’t feeling pain, I’d be a little nervous that something was amiss, because I fully expect that that’s going to be part of it. And I think that realization for athletes is part of what provides that little bit of jitters on the starting line or a lot of jazz.
Trevor Connor 31:55
So what I find really interesting is, I think something that you can train is that fear of pain. And so I think this is where cycling is a really great example, because anybody who has raced knows those first few times you’re in a peloton, it is scary. And what you are scared of is at any moment, I could bump wheels as somebody I’m going to go down, a bunch of people are going to land on top of me, and this is really going to hurt. They did another study where they talked to top pros, again, cyclists about this, how do you deal with this? This notion that you could end up in the hospital, you could get really hurt doing the sport you’re doing because you’re going really fast, particularly downhill. And they were in the study very surprised by the response of the pros. They were expecting them to say, “No, I’ve really built my skills so I don’t think that’s an issue anymore.” All of them were just like, “Oh, yeah, and I’ll end up in the hospital at some point.” And they they continue with that dialogue and said, “Are you okay with that?” And they went, “Yeah, it’s part of my sport. It’s just going to happen. You know, every race I go into, that’s a possibility. It’s just what it is.” And so what you’re seeing is that just to, I’d almost say to an unhealthy level because I’ve experienced this myself, a complete lack of fear of pain. And when I was racing at my best, I noticed that. I look back at some of the things I did, and just went, “That was insane.” And when I realized I couldn’t compete with the pros anymore, it wasn’t a loss of strength. It was I was sitting there in the peloton going full speed and going, “Oh, my God, what are we doing? I could get really hurt here.” And I started feeling that fear. And I couldn’t stay at the front of the peloton anymore.
Grant Holicky 33:32
Well that changed when I had kids. Like I crash, I’ll break a collarbone whatever, it takes a little bit of time to come back. Totally different when you have a four and seven-year-old and you’re like “I want to cry.” Or went back couple years ago, a two and five-year-old, “I’m going to crash I can’t pick up my kid anymore.” And it changes how you approach the sport and the risks you’re willing to take.
Scott Frey 33:51
Well guys, I’m going to say that it also changes when your kids are grown, and you’re pushing 60 years old. And you don’t bounce back so well when you hit the pavement. So you find yourself gravitating to things that have less likelihood of getting that kind of pain. But I did want to go back to something that Trevor mentioned earlier regarding endurance athletes, and we sort of let off a little bit with this. And that is that it is true that endurance athletes when we look at them in the lab, they can tolerate more pain. We can induce pain, like I was describing with cold or some stimulus that they’re not actually experiencing in training. They’ll still rate it and say “Yeah, it’s painful. This is really painful,” but they can tolerate it longer. And one possibility is that, of course correlation, there’s a self-selection bias. And people who have the better ability to tolerate pain, stick it out in these kinds of sports. And that may be true to some extent, but I would argue that there’s a big learned component here. Because if you compare endurance athletes with strength athletes, which is how people have tried to do this and comparison and lab to sort out that direction of causality, you don’t see the same ability to tolerate higher levels in those strength athletes versus controls in most of the studies. And so I do think that this constant dipping our toes into the discomfort zone, getting comfortable on the emotional side, right? Tapping into that more psychological side, appreciating this as a context where we’re safe. We’ve been here before, your PAC riding aside, is really the critical sauce here; the secret sauce that’s allowing us as endurance athletes to get better and better at tolerating that.
Grant Holicky 35:37
I think it’s why it’s so important as a coach or as an athlete to do intervals to get to that place. You’re not just training the cardiovascular system in the legs to tolerate more lactate or clear it or do you know, all of those things or raising the threshold of what you can be at. It’s also understanding that I can be comfortable at this uncomfortable state, this painful state. And so you’re not just training the legs with interval work, you’re training the mind as well to sit there and be okay with it. How do I tolerate it?
Trevor Connor 36:13
Having worked at the US Army Research Institute, Dr. Robert Kenefick, is no stranger to adapting to pain. He talked with us about both taking the fear out of it and making it more bearable.
Taking the Fear Out of Pain
Dr. Robert Kenefick 36:24
So pain is a very, very complicated topic. And so the pain I can talk a little bit to is really the pain that you might be associated with physiological outcome. Like what we’ve mentioned, a buildup of lactic acid which actually causes a sensitization increases sensitization of pain receptors, and to feel that pain is different than other types of pain. And that can be related to fatigue as well. You know, one of the ideas that we’ve mentioned is this concept of doing intervals to get this physiological adaptation, because you’re going to that high intensity level, in the circumstance, we have a lot of lactic acid built up, you feel that pain. But there’s also a psychological adaptation to that as well, where you’re in that circumstance, you begin to get used to it to a degree, and you feel that. I can remember the times I was swimming in college and those intense workouts where I would be in that pain, you would get scared, some rowing workouts, and I was doing CrossFit as well, as you’re in that pain and it’s fearful, it’s a place where you haven’t been but you know, the more and more you go there, the more and more I don’t want to say comfortable, you are there, but you get there and you understand like, “Okay, I’ve been here before. I’ve had this experience, it did not kill me, I can get through it because I’ve gotten through a before.” You know, you kind of almost settle into it a little bit, not to say that you get used to it, or it becomes comfortable, but it just becomes more bearable. And it takes a lot of that fear component out of it, where you’re thinking, “Well, you know, I’m right on that edge of of losing control of being out of breath, and the pain is so bad I don’t I feel like I can’t move my limbs anymore.” But then you can. So I think that’s that’s another very important aspects to pain and doing that kind of work.
Rob Pickels 38:08
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Different Levels of Pain
Grant Holicky 38:58
You know, we used to talk with our swimmers that the short distance was like being punched in the face. It hurts more, but it’s short, right? The middle distances were like kind of get put in a burlap sack and just beaten for a while. It’s uncomfortable, it hurts, it’s a little longer, but doesn’t hurt like he got punched in the face. And distance swimming was like somebody grabbing your hair and pulling it for 15 minutes. The pain’s not excruciating. But you’re really want it to be over. And so there’s different levels of pain, you’ve got to understand all of those things in a racing context because you could do a 50k skate ski like you did the other day and you’re gonna have moments where you’re getting punched in the face. The majority of it might be like your hair’s being pulled. But you’re gonna have those moments where it’s really hard and you’re begging for the downhill. And so understanding those and getting used to them is important.
Scott Frey 39:52
Yeah, I think in any kind of race situation once we get beyond the races that take a few minutes, there are going to be these fluctuations in time. And like you mentioned, I was in a long Nordic race the other day, those hills are really intense. And that’s where the race gets sorted out. It’s like a bike race in that sense, and you want to stay with your competition. And that’s like getting punched in the face. And then you’ve got to get your wits about you and be in for the long, grinding, gnawing pain that comes with doing 50 kilometers, or whatever kind of distance you’re doing and an endurance event.
Trevor Connor 40:28
Yeah I found it really fascinating in that study that you sent that looked at this, where they took endurance athletes, soccer players, and non athletes and compare them on these different metrics of pain. And what you saw was the athletes definitely had a higher pain tolerance and the non athletes. They also had a lower perception of pain severity than the non athletes. But when you got to that pain, tolerance, that ability to just handle the pain, what you saw was the endurance athletes had a much higher pain tolerance. Soccer players didn’t have a higher pain tolerance than the non athletes. They also mentioned that study, as you’re bringing up soccer is kind of an in between sport. If you take a pure strength sport, what you tend to see as they have a higher threshold for pain, but they don’t have the endurance.
Scott Frey 41:18
Yeah we’re practicing pain tolerance all the time. It’s a big part of what our training is. And that’s why I think it’s so important that we, when we’re thinking about what’s coming about when we’re doing that 20% of our training `intensity work, or even those long distance rides, which do as Rob was pointing out, at the beginning, have a certain element of discomfort associated with them. That is an important part of our training. We’re not just training our mitochondria, we’re not just training our ability to tolerate lactate, and process it, we’re training the psychological machinery as well, and the physiology that underlies that.
Sensory Feedback of Pain
Rob Pickels 41:57
We’ve spent a lot of time on the psychological side of things. And the conversation that we’ve had has really shown me a lot that I had never really considered before. But I do want to shift gears to the sensory side, right? And I’m aware of a couple studies where, in athletes, endurance athletes, cyclists, they blocked the sensory feedback from the muscles, right. And so I’ll describe one, but Scott, I’m sure there’s maybe more that back this up, there was one where cyclists were given a fentanyl block, kind of the same thing you do when you get a spinal and a lady is giving birth. And what happens there is the sensory feedback from the muscles to the brain is essentially cut off. The brain can still tell the legs to work. So there’s no change in strength for these athletes, but the legs are no longer telling the brain how they’re feeling. And at first, you say, “Wow, that’s got to be incredible for performance.” And I know when I went into reading this study, I was like, “These fentanyl block people are going to crush it. “And that’s not necessarily the case. Because what we see is the athletes who receive or when athletes receive the fentanyl block, they go out of the gate like gangbusters. They are going so hard, they think that they feel great, but guess what happens? The body says, “Uh oh, I can’t actually do this,” all the other downstream physiological processes start to break down. And ultimately, performance is not better than when you could feel pain when you were getting the appropriate sensory feedback.
Scott Frey 43:35
Yeah, that’s a great study. And one of the few that’s really tried to get at the central issue that people working in this space are trying to disentangle. What slows us down? Is it effort, right? And some kind of governor on that? We talked about the central governor concepts and so forth, or is it pain? And it’s very difficult to disambiguate those two things. I can bring you in the lab and inflict various kinds of pain on you, right? We can always wonder about the psychological profile of people who volunteer for pain studies.
Grant Holicky 44:09
Or those that give them.
Scott Frey 44:10
Well, yeah, that’s an incisive comment. Yeah. So we can bring you in in the lab and have pain without effort. But it’s extremely difficult to study effort without pain. That study you mentioned is one of the few that pulled it off. And we discovered that in fact, pain was there to, it’s not only there to protect us, but it’s also to help regulate effort. It’s your friend, you need to start looking at it like a positive form of feedback. And I mean that in all seriousness.
Trevor Connor 44:37
We always talk on the show about the importance of pacing. You know, learning what is the right pace, whether you’re going to have a five minute climb or a one hour climb, the pace is going to be very different and ultimately, a big part of the signaling that you’re listening to is pain.
Grant Holicky 44:51
Well, didn’t you I think you guys talked about this the last time you were here that pain of the first step of a marathon versus the pain the first step have an 800 meter run, like what those things feel like and the pacing that immediately goes into that because your brain has adjusted all of those things all the time. And I’ve said this before, and I’m a big believer in one of the things that we’re not teaching youth athletes is getting comfortable with being uncomfortable. You don’t have to be in pain, you just have to it’s exercise is uncomfortable. And I think some of the team sports, football, soccer, I played those sports, and you can get away with the vast majority of the time not really being uncomfortable. You get to recover from the efforts over and over and over again. Endurance sports put you in that place and frankly, if you’re going to stay fit, as you get older, stay thin as you get older, that’s the kind of exercise you’re gonna have to do is just keep going, just keep moving. And it doesn’t have to be hard all the time, it can be walking. But if you walk long enough, it’s gonna start to get uncomfortable at the end. And that’s one of those things that I think athletes really need to come to terms with. I used to say to athletes, “How you feel doesn’t matter.” And in some context, that’s incredibly true. You can still be fast when you don’t feel your best. But being in tune with how you feel is crucial to understand what you need to do for your training, and understand what you need to do for your pacing and understand what you need to do to not hurt yourself.
How to Build Up Your Tolerance of Discomfort
Trevor Connor 46:28
Let’s hear from Coach Joe Friel and his thoughts on how to build up our tolerance to discomfort.
Joe Friel 46:32
The starting place when I talk with athletes about very, very hard workouts, is that we’re going to build to them over a period of time. We’re not going to go out and take an athlete and have them do aerobic capacity intervals on a hill someplace right off the bat unless you’re ready for that. Most athletes are not ready to do something like that when they’ve come to me for coaching. What they’ve done is they’ve been doing more than likely lots of random stuff, and they occasionally touch on pain, I don’t really like the word pain and used in this context, I like discomfort, more likely, it’s about the use of the athlete. Pain sounds like something has happened to you when you go to your dentist. And somehow it’s got a negative connotation to me. So I try to avoid that word, use just discomfort is what you’re gonna experience. And of course, I want them to do is to start classifying this level of discomfort they experienced they do certain types of workouts. So for example, let’s say we’re doing at some point, we build up gradually to the point where the athlete is doing these hill intervals, aerobic capacity hill intervals at you know, 100 and 120% of their functional threshold power on a steep hill. And they’re they’re holding this effort for two to three minutes, which is very, very, if you will painful. That’s very, very difficult to do, especially knowing you’re only going to recover for a couple of minutes afterwards and go right back into another one on top of that. And so what I want the athletes to do is when they’re doing this is to start putting RPE numbers. Riding into perceived exertion numbers on this, instead of just power number. So what I want you to do is to tell me, you know, when you did these intervals, what was on the first one, what was your RPE? How do you feel on a scale of one to 10 how hard was that for you? And they’re more than likely going to say something like an eight. It wasn’t really all that hard, you know, they will well within themselves. If they could do an eight for two minutes, even though they were at 120% of FTP, they’re working, they’re giving it a hard effort. But that hasn’t gone to the point yet where it’s really all that hard for them. They can do more. And so this happens over time. And as they progress through this workout, let’s say we’re going to do eight of these or something along that line, what was the RPE on the second one, and the third one and the fourth one? Because what happens is, is that RPE is related to duration. It’s not just intensity, it’s intensity plus duration. So for example, if I’m talking with an Ironman triathlete, and I tell them I want them to do the bike portion of the race at 70% of their FTP, they’re gonna tell me that’s too easy. But I’m gonna tell them, they’re gonna be out there for five and a half to six hours and guess what, the last hour, hour and a half is going to be hard at the same intensity. So intensity is not just a number that is achieved in isolation from everything else. It’s a number that’s achieved in relation to duration. So if you’re doing eight two minute intervals on a hill, that aerobic capacity power output, if you start giving me the RPE on those how it felt and I want you to realize that I’m going to ask this, when we talk about this workout at the end, how hard was the first one? How hard was the second one on a scale of one to 10? Start telling me that. Start thinking about that. So when you get done, you can record what these were like. Then we’ll go back and talk about why they felt that way to you? What was going on? What were your power numbers right into the power outputs or the RPE that you were experiencing? So we can start to see relationships between power output and RPE. And we’ll even pull in heart rate. But for that type of workout for two minute interval, heart rate is not going to tell us very much if we’re doing seven, eight minute intervals, different story now. Heart rates and tell us a lot more. So then I would pull in heart rate also. Tell me what your RPE was for this eight minute interval, what’s your power was was eight minute interval, and what’s your heart rate or what your RPE not left out, but heart rate, RPE, and power for each of these intervals. If you can do that for me, we start thinking about all these things in the context of what’s happening, as opposed to “Man, that workout was hard, it was a eight on a 10 scale for the entire workout.” I want to talk about it in pieces, just the individual pieces that were hard. How hard were they? So we can start having context that has to do with duration also. So the athlete begins to realize that discomfort, because of a high RPE is not simply intensity, it’s also duration.
Scott Frey 51:04
These are skills that can be developed, and they’re developed, we’re practicing all the time. Whether we thinking about it that way, when we go out to do the set of intervals our coach prescribes for us or not, that is also practicing tuning in to those signals and learning where the sort of thresholds lie. And I think it’s really important for athletes to understand that. That training is not just about muscle physiology and cardiovascular fitness that it is also involving this kind of neurological and psychological side. And it’s equally important.
Trevor Connor 51:41
I think, before we shift gears here, one last important thing to mention in that study that you sent us was they did look at personality traits that correlate with ability to handle pain. And the one that they really found that correlated strongly was grit.
Scott Frey 51:57
Rob Pickels 51:59
So on the training side, we’ll relate a little story as people know, I’m a very carbohydrate centric person. And yesterday on my long ride, as I’m training for this big ol week in Portugal, I have coming up, I took in more carbohydrate calories per hour than I’ve ever done. I was at about 120 grams an hour. And I was remarking earlier to the group but yesterday, I still remember the profound feeling I had four hours into the ride as I’m starting my climbs to finish the ride. How good I felt, and knowing that this episode was being recorded today, I really had this question of, “Well, what about no pain no gain? I feel so good right now, I can’t possibly be getting good training.” Because we’re so used to, “Ugh, I worked so hard, I am so tired, I went so deep and it was beneficial. Scott, what are you seeing on the no pain, no gain side of things?
Scott Frey 52:54
Yeah, I think I’m probably seeing it very similar to the rest of you. And that the key here is limited doses of this and doses that you can actually recover from. If we’re talking about pain as being that kind of searing intensity that encompasses those very hard training things. Something like you’re describing, right, the kind of exhaustion that comes with being out in the mountains for a long, mountainous ride like you did the other day. There are things you can be doing during that ride to help buffer that experience and keep things going well, I think it’s no secret to any of us that the first symptom of your blood sugar starting to drop is emotional and mood, right? I start to get pretty dark. And I know I’m pretty tuned in now. And I know if that starts to happen, boy, I better slam a gel quickly or get something in my mouth because this is headed in a very bad direction. Staying on top of that anticipating and feeding before you need to can make that experience so much better and allow you to tolerate that discomfort that you’re inevitably going to experience.
Rob Pickels 54:01
Yeah, Scott, you have a note here that says chronic pain lowers pain threshold. We’ve talked a lot about how being an endurance athlete improves pain threshold. How do we rectify those two things together? Can we is is this chronic pain that I’m experiencing day in and day out from training? Does that have a positive and negative effect on my threshold?
Scott Frey 54:20
Yeah, it’s something that really strikes me because in studying pain in patients with injuries or neurological conditions, one of the things that we talk about is what’s called Central sensitization. And that’s an increased sensitivity to pain that we see in people who have chronic pain like those phantom limb sufferers, or grands and uncle, unfortunately, but we see just the opposite kind of thing going on when we are in control of the pain doses that were receiving. And I don’t think we have research that can really clearly differentiate what’s going on in those two, but my guess would be it gets back to this idea of context. So knowing that you’re in control of your pain is very different than being subjected to pain. And I bet that there are athletes out there who can really go deep into the well and sit with that in their sport of choice, but probably also wince in pain when they have to go get their flu shot.
Grant Holicky 55:19
Absolutely. And you’re exactly right, people who are chronically in pain from my my thing on that was you wake up and you know, it’s coming, you’re dreading it. And that’s something that we’ve kind of talked about the catastrophizing of pain in a racing setting, or worry about it, if you know it’s coming, that dread, really, really plays to that.
Trevor Connor 55:43
That’s something I can really talk to, because I suffer from migraines, and I will still say the most painful experiences I’ve ever had in my life or migraines. And when you get that first mild sense of pain, I am acutely aware of it because a I can’t control it. And be it’s always, is it just gonna stay like this? Or am I going to be on my couch, writhing in pain and you don’t know and you have no control over it?
Scott Frey 56:09
Very different situation than in a time trial, for example, where you know that eventually the finish line is coming up. And if you get to that place where it’s just too much, you can dial it back a little bit, and it’ll go away immediately.
Rob Pickels 56:23
Yeah, this is interesting. I’m thinking about the chronic pain lowering thresholds with the athletes, and bring this back to the earlier part of our conversation where I believe, Trevor, you said, when you’re in pain and not feeling good, you want to go to the front of the race, because what’s the difference? Now you’re in control, right? And, you know, Grant, as you are saying, it’s the pain that you don’t have control over, it’s just there. That is the pain that potentially lowers somebody’s threshold, but as an athlete, when you’re able to inflict it on yourself, and we’ve talked about this before, I get the most nervous for Zwift racing. And I’m making this epiphany now because I’m not in control of that pain. You’re quite the opposite. Exactly. I’m along for the ride, it’s somebody else, you know, and I can do really well, if I am doing my own workout by myself, then I think I feel like I’m in complete control, but was probably important is to reframe my thinking, so that I’m not going into this with race thinking I’m at the whim of everyone else. I need to take some control dammit.
Grant Holicky 57:33
Yeah. And I think it also comes back though, to the process piece of like, this is part of the part of the gig, right. And I talked about Zwift racing is such a great tool for my outdoor athletes gone. If you don’t care about where you finish, just go in there and just sit with it. Just find those places to be I know, I’m going to be uncomfortable. Just embrace it do don’t worry about what what the finish line is, there’s somebody in there weighing 90 pounds, my air quotes aren’t seen on the on the podcast, and they’re putting out 400 watts, 600 watts, like, you just got to kind of accept it. And I think coming back to the chronic pain thing. Unfortunately, for a lot of those people, there’s no means to the end, they’re not getting to the end, they don’t have to tolerate this in order to get this. This is just part of it. And that is debilitating when you get into that place.
Trevor Connor 58:25
Something I found really interesting in this, this other study the athletes inclination to play through pain, a coping perspective. They looked at the variety of different ways in which we can potentially cope with pain. And there was a huge list right down from praying to just ignoring the pain. What I found fascinating is is they found the one coping strategy that worked is the one that you would think now that can’t work, which is just ignore the pain that athletes just kind of go, Yeah, I’m just going to try to ignore this. And I think of one of the toughest athletes, cyclists I’ve ever met, Swain Tough. I asked him how he dealt with pain and time trials. And he goes, Yeah, I just put the pain on the to do list and told myself, I’ll deal with it later, which is effectively just ignoring the pain. And I do something I’ve learned to do something similar of kind of compartmentalizing the pain and saying, just telling myself, that’s a signal. It’s just my body telling me something and it’s useful information. But to try not let it be anything more than that.
Grant Holicky 59:28
I think that’s the important key because I think what our listeners don’t want to kind of get twisted is if I ask you to think about anything, like really concentrate on think about it and now don’t think about it at all. It’s still going to keep popping up in your head. And so that truly just ignore it is almost too flippant. It’s ignore it, because it’s part of what we’re doing. This is just something we’re used to this is something that I have to accept. I think accepting might be maybe a more correct term. In that it’s all semantics, right? Whoever wrote the study decided on what that word was going to be. But I don’t want people to just say, oh, you know, yeah, I can just ignore it, you can ignore it, it’s going to keep popping back up. But how you choose to live with it is really important.
Scott Frey 1:00:16
Yeah, I think you both bring up a really good point. And it touches on the common thread of attention. We have this wonderful limited bottleneck of attention that really allows our conscious experience of things to be pretty selective, right. And so if your entire consciousness during that event is being tied up with how much you’re suffering, that’s going to really take away from your ability to think about maintaining a cadence, maintaining form, maintaining your strength and working the course to your advantage, right? So you will benefit to the extent that you can, maybe not ignore the pain, but try to shift those limited resources that we all have cognitively and attentionally, to those things that are going to help your performance because the pain is going to be there.
Grant Holicky 1:01:06
Yeah, there’s a great study that they had people doing math problems while they were writing, and the pain went down, because their attention was on to something. So you can shift that attention dramatically. And again, it comes with practice.
Scott Frey 1:01:22
Yeah. Wouldn’t it be interesting if your head unit had a pain readout? I think it would probably not be a good thing.
Grant Holicky 1:01:28
It’d be bad. Yeah.
Trevor Connor 1:01:29
We already had that. But I agree, I think the biggest mistake you can make is to sit there and focus on the pain, because that gets into that catastrophizing where you’re just going to make it worse and worse and worse. And I think be aware of the pain, but just make it one of the things that you’re aware of. And I can tell you from experience, I’ve learned very quickly, when I crash, as long as I can, as long as my body is functioning, I tried to get back on the bike as quickly as possible. Because if you’re sitting there on the side of the road, or the side of the trail, in pain, there’s only one thing to focus on is the pain. If you can get back on the bike and start riding, then you have other things to focus on and the pain becomes reduced.
Scott Frey 1:02:08
Yeah, I think this is why I prefer nordic ski racing.
Grant Holicky 1:02:13
You get cold when you crash. But that’s about it.
Rob Pickels 1:02:15
Well, but you can lay in the snow and ice the injury. Yeah, Scott, we’ve talked about how we improve a lot of these parameters just through the racing and training that we’re doing. But can we specifically train? Is there a protocol to help improve this?
Scott Frey 1:02:33
Yeah, I think that on the sports psychology side, there’s been a lot of work on helping people to really address one of the components of pain, which is this emotional side. The things that have been coming up in this conversation, really trying not to catastrophize to accept that this is part of the feedback that you’re getting. And to really start to reframe the experience that you’re having, right, because again, this is being constructed inside of you. And you do have some control over the extent the quality, I would say, of the experience that you’re having with that pain, trying to let go of the fear element, and realize that this is an important form of feedback. There have been some also some studies that have looked at preconditioning pain. So for example, keep going back to this cold water way of inflicting pain, but it’s an easy thing to do in the lab. And if you precondition people with pain like this, it actually does have an effect on a subsequent painful experience. That could be something like performing a workout on a time trial and an erg or something like that. So there is this potential that we might be able to do this. Maybe that’s part of the point of doing a really good warm up that isn’t just super slow and easy, but dips into a little of what are you going to be experiencing when that race kicks off? Going back to the Zwift races, there are a lot like cross races, they start going 110%. Nobody’s going to sustain that. But you need to know that right? And you need to know that you can sit with that for a limited amount of time in order to hang on to that group. And being prepared for that by doing a proper warm up where you get a little taste of what’s to come. Might be a nice way of preconditioning that or this
Rob Pickels 1:04:16
Is Trevor going around prior to a race looking for people that he strongly dislike.
Trevor Connor 1:04:23
You’re never gonna let me go on that one.
Grant Holicky 1:04:27
Rob Pickels 1:04:27
He’s inflicting mental, emotional pain on himself.
Scott Frey 1:04:32
Or you can just get a friend to punch in the face?
Rob Pickels 1:04:34
Oh there’s that too, but only for short events because that’s what punching you in the face is like.
Scott Frey 1:04:40
Maybe pull your hair
Trevor Connor 1:04:42
As the 52-year-old Ultraman champion, Dede Griesbauer, is no stranger to having to tolerate discomfort for very long periods of time. Let’s hear how she manages it.
Dede Griesbauer 1:04:51
I think you just become so accustomed to it that I not sure I would know my life without it. It’s such a constant companion that I almost miss it when it’s not there. And that sounds totally twisted. I realized that but we trained for it right. So while it does hurt, it’s a familiar feeling. And I think there’s something somewhat comforting in that in that we prepare for it and the reward at the end. For me, in the last, I’ll say, 15k of my ultra man race, I was in a world of hurt, it hurt a lot. But the prospect of becoming a world champion at the age of 52, the first time in my sporting career that overpowers the pain, and that provides the motivation to keep going. So while there is pain, there’s an overriding motivation that carries you forward.
Ryan Kohler 1:05:46
Hey, listeners, this is Ryan Kohler, coach, physiologist, and owner of Rocky Mountain Devo. Whether you’re a competitive athlete or a fitness focused individual, Rocky Mountain Devo has a place for you. We provide coaching, nutrition, lactate and metabolic testing and training plan guidance, so that you can get to where you want to be. Check us out today at rockymountaindevo.com.
Trevor Connor 1:06:10
The most painful race of the year is always the first race, because you just have no tolerance for the pain. And you have to do those races just to learn how to start to become okay with the pain.
Grant Holicky 1:06:22
As then there’s a big unknown to when you don’t know what’s coming, it gets into this fear. And that first race speaks to that, too. It’s that unknown. Like, I don’t know, this is what’s coming. That’s why I like to put intensity into people’s training, even early season, to remind them of like, it’s gonna feel like this. It’s not an unknown you’ve been here.
Scott Frey 1:06:44
Yeah. And I think an important thing that both of you are touching on here, again, is this idea of establishing a context in training at least some of the time that is really close to what people are going to experience in a race. So you can get athletes who can go out and really nail those painful VO2 max workouts when they’re alone, but still have trouble staying on somebody’s wheel, when that person in front of them is the one who’s doling out the pain and in control of it. And they need that exposure to not being in control of the pain in order to be able to exercise that full capacity that they’ve developed so well in their solo training. And I guess that takes us back to the beginning of you know, what is the value of things like group rides, or the Zwift drives where at least you’re not going to have to worry about the crashing, right, and you can really let it rip. And the consequences of going too deep and blowing up are pretty minimal, you can just climb off and get something out of your refrigerator.
Rob Pickels 1:07:47
Well and this is where motor pacing comes in. Right. As an athlete, you’re not in control, you’re hanging on for dear life sometimes.
Trevor Connor 1:07:53
That’s something I’ve been fascinated with because they’ve never done a single study on motor pacing. And I’ve talked to a lot of coaches about what is the benefit of motor pacing? If you look at the power, it’s not all that bad. So why do you do this? What are the benefits to it? And the answer that I gotten again and again and again, is it’s learning to be uncomfortable.
Rob Pickels 1:08:13
So I think that there’s a little bit of an elephant in the room. And we would be remiss if we didn’t talk about another coping strategy that athletes can use and sometimes abuse in my opinion, and that is pharmacological aid. You know, we talked about fentanyl before I don’t know that a lot of athletes are going that far. But at the very least they’re using ibuprofen, acetaminophen, other over the counter pain relievers. How does that tie into the rest of this conversation? Is that helpful? Is there negatives I don’t know from a health perspective and when we talk about your organs if that’s something you want to do, but Scott, what are we seeing for pain perception and pharmacological agents with athletes?
Scott Frey 1:08:53
Yeah, I think there’s really two things here, right? There are two routes you can go to start to address how you can address pain in ways that get the most out of people. And one area of research is looked at the pharmacological option. The other is what we’ve been talking about conditioning and training and learning and practice. That research is interesting. Going beyond the extremes of fentanyl. One of the things we know about placebo effects is they actually are working through circuits in the brain that are involved in the release of our own internal opioids. Right. And so one of the interesting studies that I saw done by one of the big placebo researchers, Benedetti was to take some elite cyclists and administer on two occasions, an opioid pain blocker before their training. And then prior to competition, administering a placebo where they thought they were getting the dose of the pain blocking opioid, and it did appear to have this kind of enhanced placebo effect on their performance. And what I don’t think we want to suggest is that people should running around preconditioning them selves in training with opioids to block pain, because that’s crazy and illegal. And we wouldn’t want to encourage that kind of thing. I think pain is there to protect you. Again, getting back to the point, to the extent that you pharmacologically block that out, it’s at your own peril. So what else caffeine caffeine is interesting, right? Many of us love caffeine, most abused drug in the world. And it does seem to help to improve our ability to tolerate pain. So we know caffeine has performance enhancing effects. And there are things about dosage and time and individual differences, of course, but one of the ways it might be doing that is by allowing us to tolerate a bit more pain in the heat of battle.
Trevor Connor 1:10:45
And caffeine also seems to enhance the impact of some painkillers. So that’s something I can talk to because I’m not a big fan of painkillers. But when I have a migraine, and you’re writhing on the couch, all that stuff goes out the window, and you start taking the painkillers and it’s actually they’ve shown again and again and again in the research that taking a an anti inflammatory pain medication. With caffeine has a much more significant impact on migraine pain than just the straight painkiller.
Scott Frey 1:11:16
Yeah, just to touch on the sensory side, we talked about the specialized nerves, these nociceptors, right, there are three varieties, that one that responds to thermal pain, one that responds to mechanical pain, and one that responds to changes in acidity and pH. And that’s probably a big one that we are dealing with, at times when we’re getting that sort of localized muscle pain feelings and so forth, and modulating those, again, I think we want that feedback. And I think that’s an important message. Thank goodness, we do have ways of modulating pain in non competitive situations, however, for conditions like what you described.
Trevor Connor 1:11:55
But important thing to remember, again, there, there are multiple studies on this, that taking painkillers, reduces the adaptations that you get from exercise. So there’s a unfortunate a lot of athletes to go and do a hard workout and they go, well, that hurts. And I’m going to take a painkiller, not realizing they just undid literally half of that work.
Rob Pickels 1:12:13
Because of the anti-inflammatory effect. Yeah.
Grant Holicky 1:12:15
There’s even some research that shows that anti-inflammatory drugs like ibuprofen will lower lactate threshold sooner and earlier during workouts and during races. And refuting some of that idea of the vitamin I mentality of trail running and some of those other ultra long endurance sports.
Rob Pickels 1:12:35
I mean, it is it’s quite prevalent, especially in some of these longer off road, where it’s the normal thing to do is that everyone is just popping some pills beforehand. And I’ve always been concerned from a what is this doing to my liver and my kidneys? As I’m dehydrated and pushing myself? I don’t I don’t want to go there. Yeah, exactly. Yeah, those nociceptors are really tuned to inflammation as well. And we we really do want that feedback.
Trevor Connor 1:13:01
Well, I think we’re at that point, we got four of us. So we probably have some good take homes here. So Scott, you know, the routine, you got one minute, what do you think is the most salient message for our listeners to hear today?
Scott Frey 1:13:12
Yeah, I think the salient message is that pain is a perception, it’s being created internally. And that as athletes, we need to learn how to experience that discomfort in ways that detract as little as possible from achieving our peak physical performance. And that the way to do that is to start to really reframe what that pain means. We have some degree of control over how we view that pain, whether we let it set us into a path of feeling that it’s catastrophic and being fearful, or whether we embrace it as part of the process. And embracing it as part of the process. And learning to work with it is going to be key to getting the most out of yourself.
Trevor Connor 1:13:58
Grant Holicky 1:13:59
I think the biggest thing for me is that we have to put ourselves in that place where we’re experiencing the pain that we want to be able to race with when we’re training. And really taking a look at the mental strength side of things in our in our sport and understanding that the pain is real, and how we want to use that pain as part of the process. Instead of looking just solely at the result. “Oh no, this is what I wanted to do. This pain is a negative.” That pain can often be and I think Scott, you alluded to this earlier, that pain can almost tell us we’re doing it right. Now if I’m feeling that that’s good. I want to feel that. My last piece of this is don’t internalize everything. If you’re in pain, you’re not the only one. Get the ego out of this equation. As Frank Shorter said in the 72 marathon they said When did you know when to attack? He said I felt awful. And when I felt the worst I knew they felt bad so I went for it.
Rob Pickels 1:14:59
For me, you know, pain should not be the point of what we’re doing. But it is integral to what we’re doing. And we need to understand our relationship, we need to prepare ourselves for that ahead of time. And we need to control as much as we can, how we’re perceiving pain. On the other side of it with the sensory side of things, we don’t necessarily want to be blocking that pain. We don’t want to be doing things that are removing the pain because it is very, very valuable feedback, for our pacing for how things are going. So while I don’t necessarily prescribe to a maybe a no pain, no gain sort of mentality, I do think it’s important that we have some of that in in our daily lives and in our athletic lives, too.
Trevor Connor 1:15:47
So I actually had kind of an aha moment when I read the research for this where it talked about how endurance athletes have a higher tolerance for pain, but not necessarily a higher threshold. That was kind of an aha moment for me, because I know I have a bit of a reputation as sometimes being a hard ass. And people have told me “Oh, you have a real high threshold for pain.” And my response is, “No, I don’t as a matter of fact, I think I have a below average threshold for pain. I’ve just learned over the years how to tolerate it.” And here’s research showing that’s kind of the case with endurance athletes, and I know this episode has been very focused on racers where you go through a lot of pain, but anybody who’s doing any sort of endurance work just going for a run doing a long ride. There is a low level amount of pain and I think the the mindset that we need to have is not to try to get to that point where you don’t feel any pain. I think the what you need to get to is that point where you say I feel the pain and I’m okay with it.
Rob Pickels 1:16:50
That was another episode of Fast Talk. Subscribe to Fast Talk wherever you prefer to find your favorite podcast. Be sure to leave us a rating and a review. The thoughts and opinions expressed on Fast Talk are those of the individual. As always, we love your feedback. Join the conversation at forums.fasttalklabs.com to discuss each and every episode. Become a member of Fast Talk Laboratories at fasttalklabs.com/join to become a part of our education and coaching community. If you like what we’re doing and want to support us, go ahead and check out our Patreon page, send us a little love. For Scott Frey, Grant Holicky, and Trevor Connor. I’m Rob Pickels. Thanks for listening!
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