Pain and Performance, Friend or Foe?

In the box, the hurt locker, the pain cave. Every athlete has ventured to these places countless times to get the most out of themselves during competition, but how much faster can one go by simply saying “shut up legs”, and are there ways get around the suffering?

We’ve all experienced the burning sensation associated with sprinting to the top of a hill, the back half of a long TT or trying to complete a singular chin-up (cyclists take a good hard look at yourself). The reasoning behind these highly unpleasant sensations is physiologically important for protecting the working muscles as well as the heart.

Every muscle contraction causes minute damage to the cell membranes within the muscle (scary right?), and the more forceful each contraction the more damage occurs (visit the blog on antioxidants for why this is surprisingly useful when it comes to training). This damage to the cells release cyclooxygenase enzymes (you may have heard them referred to as COX) which essentially lead to the brain being told “ow, stop going so hard” and generating that awful sensation we’ve all felt (there’s a few extra steps in this process which you can look into here).

As it happens during a race, athletes don’t tend to be too interested in preventing muscle damage and would much rather go faster, win the race and then worry about the rest later. For this reason, managing pain, whether through fighting it or embracing it, can be a vital skill for competitors to gain an edge over their opponents. Just the act of regular high-intensity training has been proposed to alter pain perception and tolerance. Elite athletes have also been found to have a higher pain-tolerance than non-athletes but a fair chunk of that effect size may stem from those athletes being required to be naturally capable of handling pain just to get to the top of their sport.

Unfortunately, pain during exercise is a notoriously difficult area to research since pain is subjective. It’s a tough task for researchers to distinguish whether one athlete is hurting more than another, regardless of how epic one’s pain face may be. Two current areas of research have looked at ways to combat pain by either psychological or pharmaceutical means.

The power of the mind

Psychological methods include the athletes either attempting to ignore or embrace the pain. Ignoring the pain, AKA the ‘shut up legs’ approach, usually comes from mental distractions such as focusing on aspects outside the competition (crowd/scenery/etc.) or through mental imagery and positive self-talk (picturing the glory of crossing the finish line first or going to your ‘happy place’).

Embracing the pain, AKA the ‘pain is temporary’ approach, is an almost meditative process which involves accepting that the body is telling you to stop but forcing yourself to keep pushing as the pain of losing for many is greater than the pain of suffering during an event. Unfortunately, the research is still on the fence as to whether these techniques actually provide a significant performance benefit in endurance events.

Another psychological method to manage pain is called ‘end-point manipulation’. In this technique athletes tell themselves to “just make it to the next corner” or “just one more lap” repetitively to squeeze the most out of themselves. Interestingly, studies have found this can work up until a certain point. For example, athletes could be told the finish line was 500m further than they initially thought and could still maintain the same output for the extra distance. However, when the finish line was, say, 1 or 2km further than expected, athletes would ‘crack’ and output would drop significantly.

The Uncle Dougs

Given the range of painkillers now readily available to the public it’s no surprise that some athletes will also use pharmaceutical means to directly block out the pain. There’s no doubt these are effective in preventing the pain caused by intense physical activity but there’s also some health and performance side-effects of which everyone should be aware.

The common over-the counter painkillers (aspirin, paracetamol, etc.) usually act on the COX enzymes mentioned above. Inhibiting action of this enzyme means that the muscle damage caused during exercise causes significantly less pain for the athlete. This can be acutely beneficial for performance however can cause issues later as a result of the body damaging itself more than under normal circumstances. The fatigue and damage to the muscle fibres most effective for the contractions required can result in recruitment of less effective fibre groups, or just simply damage the muscle to the point where it can no longer contract as forcefully. In short events this may not be a problem but at the end of a long one-day race or in a multi-stage tour the use of painkillers can be more detrimental than beneficial.

The anti-inflammatory effect of many of these pain medications prevents the effective repair and strengthening of muscles post exercise, as discussed in this post. More worryingly, COX inhibitors have been associated with an increased risk of myocardial infarction and stroke. In a situation where the cardio-vascular system is already under serious stress (e.g. intense exercise) this is a risk you may want to think twice about before popping those panadols!

The elephant in the room when it comes to pain in sport, particularly professional cycling, is recently banned tramadol. Tramadol is an opioid medication, the same family as morphine but with around one tenth of the potency. It acts by preventing the reuptake of serotonin, meaning there’s more serotonin that hangs around in the system resulting in a reduced sensitivity to pain. As many will know, opioids do have a number of nasty side effects. Nausea, itchiness and lack of perception of necessary stimuli such as hunger and thirst can provide problems directly on the bike. The highly addictive properties of these medications can result in dependence on these painkillers and cause severe withdrawals or chronic pain when users stop taking them. Knowing this, it’s a surprise the WADA tram ban didn’t come earlier!

Take home messages:

• Pain is a protective mechanism to prevent damage
• Elite athletes have a higher pain tolerance than the general population, indicating pain management can benefit performance
• Psychological methods can be used to manage pain during exercise, though research indicates the benefits to performance are limited
• Over the counter pain medication can be effective in the short term but may be detrimental in longer events and can increase risk of cardiovascular complications
• Tramadol and other opioids are very effective at decreasing pain sensitivity but can have serious short and long-term side effects
• Research provides no clear message as to how athletes can use analgesic drugs while minimising unwanted side effects

Pain is a part of high-intensity exercise whether we like it or not. The mental strength involved in coping with this is often what sets the best apart from the rest. You can be as strong as you want in the legs but often its what’s between the ears that counts. 

 

 

This piece was written during some big travel days involved in getting 50kg of belongings (mostly sunscreen) from Melbourne to Girona. I’ll be based here for the majority of this season and I’m looking forward to some big days on the local climbs to get ready for my first Euro race of the season, Circuit des Ardennes, in two weeks. I’ll certainly be staying clear of the painkillers and from all reports the domestic racing scene in France is brutal so I’m sure to be in for a painful few days. Until then, I’ll keep reading the research papers so you can spend more time on the bike.

Cheers,

Cyrus

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