Excerpt from Pain & Performance: The Revolutionary New Way to Use Training as Treatment for Pain and Injury, Chapter 6, The New Science of Pain
Despite the fact that pain is not fully knowable, it’s not a complete mystery. Seldom, if ever, is the manifestation of pain truly arbitrary, happening for no reason at all. Pain does behave with some consistency, which makes it fairly predictable and hence preventable and treatable to a certain degree. For example, you can avoid much of the pain you’d undoubtedly experience in your legs after running down a mountain by practicing downhill running for a few weeks before attempting the challenge. Likewise, you can also predictably overcome the pain of tennis elbow or any other so-called overuse injury by following the Training as Treatment process described in Pain & Performance.
Any phenomenon that exhibits identifiable patterns in its behavior contains information, and this is true of pain. One of the keys to managing pain effectively as an athlete is finding the information in it and putting it to use. Tendon expert Ebonie Rio has observed that ruptures of the Achilles tendon occur far more often in athletes who experienced little or no pain in the tendon beforehand than in athletes who have significant Achilles pain. This is the opposite of what most people would expect, but the explanation makes perfect sense: Achilles pain motivates athletes to avoid overstressing the tendon. This is a good example of finding and putting to use the information contained in pain.
Use Pain to Adapt Your Approach to Training
Unsurprisingly, the most successful athletes tend to mine the most information from pain, using it not only to avoid overdoing it in workouts but also to learn about their bodies’ limits and evolve personalized approaches to training that minimize pain-induced disruptions to their progress. When I encounter an athlete who previously lost a lot of training days to injury but doesn’t anymore, I can assume this is an athlete who has learned a lot from pain.
Professional ultrarunner Jared Hazen is one such athlete. A true prodigy, Jared was winning major trail races while still in high school. He was also logging 150-to 170-mile weeks routinely—and they weren’t exactly flat miles. Jared’s youth allowed him to get away with this punishing regimen for a while, but in 2017, he suffered not one but two stress fractures. I started working with him the following year, when he was dealing with yet another injury—a pesky case of osteitis pubis, or inflammation in the pubic bone. In the several years that have passed since then, Jared has gotten a lot better at keeping injuries from getting out of hand, and I believe the biggest reason is that he’s learned from pain.
The process began when he won the 2018 JFK 50K after following a conservative training plan that was designed for the sole purpose of ensuring he reached the start line healthy. It was an eye-opening lesson and one he’s carried forward. The Jared Hazen of today understands his limits and respects them. He’s found a volume sweet spot around 120 miles per week, where he hangs out until just a few weeks before a race, at which point he’ll bang out a few heavier weeks, but only if his body feels up to it. When he does experience warning signals, he no longer ignores and tries to push through them or panics and stops running altogether, switching into treatment mode. Instead, he modifies his training after taking a day or two off and either calls me or starts doing some of the exercises I’ve taught him in the past. Although still relatively young, Jared is experienced enough now that he seldom experiences an issue he hasn’t dealt with before, so he knows what to do, or at least how to figure out what to do. The results speak for themselves. When Jared developed plantar fasciitis—another notoriously challenging running injury—toward the end of 2020, he reduced his running and shifted over to flat routes, replacing the running he was missing with cross-training. Thanks to this combination of self-efficacy and variation, he was back to full training within five weeks.
Be Discerning, Even Skeptical of Pain
So yes, pain is a valuable teacher. It isn’t always a reliable information source, however, and it’s good to keep this in mind in your dealings with it. A relatively new theory of consciousness called predictive processing proposes that our perceptions—including our pain perception—are based largely on expectations and not so much on what is actually happening. And our expectations, in turn, are based on past experiences, which our brains use to create models of reality that make the world more predictable. This theory helps us understand why pain often manifests in the absence of structural damage to the body and why it often persists long after healing is complete in cases when it is initially linked to structural damage. It also makes sense of why expectancy violations can be powerful tools for managing pain.
The upshot of all this is that it’s best to approach your pain experiences with a healthy degree of skepticism and remain open to the possibility that the message they seem to be sending you is misleading. In particular, ask yourself, “Does this movement hurt because it’s really not a good idea right now or because I fear or expect that I’m hurting myself by doing it?” To be clear, in expressing this caveat, I’m not dismissing the information pain offers. I’m just suggesting that like a lot of information sources, it is open to interpretation. Indeed, getting better at interpreting pain and knowing when it’s misleading you is a core part of the process.