Pain management

By David

In summer 2017, for the fourth time in a row, Kilian Jornet won a tough 100-mile race with more than 10 kilometers of elevation gain and loss: the Hardrock 100. This news wouldn’t have been any big surprise had Kilian not dislocated his shoulder stumbling and falling on mile 14. Even though he managed to pop it back into place, he had to withstand a great deal of pain during the rest of the competition. At mile 57, his crew even had to secure the injured arm to his body with tape so that he could continue running. Despite the difficulties, Kilian didn’t take any medication to ease the pain. See the video from finish here.

Now, anyone who ever dislocated his or her shoulder knows that the pain is utterly unbearable. One can read on the internet that “immediately after the accident an unpleasant pain of the affected shoulder sets in preventing from any activity using the injured arm.” As the source claims: “it is essential to avoid any movements and shakes – they are very painful indeed.” How did it come about that Kilian not only managed to run for approximately another 20 hours with such a painful injury but actually won the race?

Same place, different story. Another Spanish racer, Iker Karrera, started to suffer from unbearable stomach pain in the middle of the race. The discomfort was so severe that he eventually had to stop at one of the refreshment points and stay there for one and a half hours, unable to move further. If you saw the recording or pictures from the race then you know he endured an agonizing ordeal. Despite the challenge, he managed to run again eventually, and moreover he finished the race in an excellent sixth place. What causes this ability of ultramarathon runners to cope with pain, while most ordinary people could not continue in any activity?

To get the answers, let’s go back to the year 2009. A second TransEurope Footrace. was taking place. The overall distance to be covered by the runners was an unbelievable 4885 kilometers. However, this race turned out to be important mostly because of the study that took place during the competition: an analysis of the influence of a long-term physical workload on the human body. This research, among other things, compared a group of racers with a control group of non-runners of similar age and background. From the results obtained, the researchers concluded that indeed, ultrarunners have an increased pain threshold compared to the majority of the population. Thus, they are less sensitive to pain and can withstand it longer and better than other people.

OK, so now we know that ultramarathon runners experience physical pain differently. But why? There are multiple possible explanations and opinions on why it is so. Dolores Christensen claims in her doctoral thesis that ultramarathon runners gradually learn to accept pain as a basic fact, a reality that forms part of a run. That enables them to exist as if “beside” the pain – they know about it, they sense it, but they don’t put so much stress on it. They are somehow aware of the physical pain throughout the run, yet it seems as if it exists elsewhere.

Kenneth Kamler observed a similar ability in the Amazonian Indians, and he described it in his book Surviving the Extremes. During his Amazonian expedition, doctor Kamler met an Indian boy who almost severed his hand at the wrist with a machete. Despite the severe injury, the small boy responded rationally and didn’t show any signs of pain. Kamler explains that in the hostile jungle environment, where life is an everyday struggle for survival, suffering from pain would not make any sense. Freeing oneself from pain and proceeding rationally increases the chances for survival to a great extent.

Another explanation lies in the conviction that during a long, exhausting run our consciousness narrows down. Runners get into a trans-state that allows them to sense only a limited number of stimuli closely related to the running activity. In 2003, Andrew Mojica studied participants of the Badwater Ultramarathon, one of the hardest runs ever, and he discovered an interesting thing. He interviewed the racers, asking them questions relating to hallucinations. During the race, some runners described hallucinations they had experienced, but immediately after crossing the finish line they flatly denied them. Only after discussions with the racer’s teams did it become apparent that athletes simply could not remember a substantial portion of the race.

This state of narrowed consciousness is probably more intense in the night, and it is triggered by increasing fatigue, a lower level of blood sugar, and a decreased amount of oxygen in higher altitudes. Our brain starts to narrow attention down according to the requirements of the immediate situation. It focuses only on the fundamental physical processes, for example, breathing and forward movement. Any other stimuli, including long-term pain, are removed to the periphery of consciousness due to lesser importance. At that moment the brain assesses pain as less critical.

The last explanation is related to the “opioid theory.” Research from 2008 suggests that during long-distance running, our brains release chemical substances that act on similar principles as drugs or medication. These substances connect to receptors in the brain structures that manage pain perception. Thus, our body produces anesthetics helping to soothe the pain.

There has been yet another study focusing on pain. In 2012, Przemyslaw Bąbel interviewed the participants of the Cracovia Marathon immediately after finishing the race. He asked runners questions about the pain they were experiencing. The racers were happy they had finished the race: they were glad they had made it to the finish line. In spite of that, they reported quite substantial physical discomfort and various aches. During follow-up inquiries after three and six months respectively, when asked to evaluate the pain felt during the Cracovia Marathon, they reported significantly lower pain intensity and also less discomfort related to the run. It seemed as if they had forgotten the difficulties accompanying their marathon experience.

However, one question remains: what if the ultramarathon as a sport attracts people whose pain threshold is already high? Individuals, who are naturally capable of deadening the pain they are experiencing? In such cases practicing our sport would have had a much lower influence than was claimed. What do you think? What is your experience? Leave a comment.