Exploring the Pain Cave with Lloyd Emeka MSc, PhD(c) #219

View all show notes and timestamps on the KoopCast website.

Episode overview:

Lloyd completed a BA (hons) in Business Administration at Staffordshire University and an MSc in Marketing Management at Aston University. He then proceeded to work in the advertising industry for several years before embarking on a career change in 2016.

Lloyd returned to academia after a thirteen-year break and completed a Postgraduate Diploma (conversion degree) in Psychology at Birkbeck, University of London. After completion of the postgraduate diploma, Lloyd studied for an MSc in Applied Sport Psychology at St Mary’s University and graduated in 2021.

Lloyd has also held several committee and board member roles at the British Psychological Society (BPS), and he is currently Past Chair for the BPS London & Home Counties branch and an editorial board member for Sport & Exercise Psychology Review (SEPR) which is an international, peer-reviewed publication.

Episode highlights:

(25:17) What is “real” pain: associations between perceived pain and injury or tissue breakdown, societal portrayals and associations between pain and injury

(40:33) Seeking longer distances: graduating from 50 to 100 miles, adapting to the challenges of longer distance, the distance gap between training and racing, attraction to the unknown, challenge through duration versus intensity, being content with your race distance

(45:02) Athlete takeaways: capability through knowledge, discussing pain with peers and your coach, reflecting only our personal pain narrative, pain and prevention, managing pain is a learned skill

Additional resources:

Papers discussed-

‘Pushing through the pain cave’: Lived experiences of pain tolerance in male ultra-marathon runners

Portrayals of Pain in Children’s Popular Media: Mothers’ and Fathers’ Beliefs and Attitudes

LLoyd on X: @nathan78

Academic profile: https://www.stmarys.ac.uk/staff-directory/lloyd-emeka-staff-profile
ResearchGate profile: https://www.researchgate.net/profile/Lloyd-Emeka
LinkedIn: https://www.linkedin.com/in/lloyd-emeka-msc-gmbpss-1262662
https://www.frontiersin.org/articles/10.3389/fpain.2022.898855/full

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Transcript

Speaker 1: 0:10

Trail and Ultra Runners. What is going on? Welcome to another episode of the Coupecast. As always, I am your humble host, coach Jason Koop, and I am back from a one week hiatus. I apologize to you frequent listeners of the podcast for a little bit of a break in the schedule. I just could not get around to all of my duties, as otherwise specified last week, with some travel and some other things going on. But we are back this week and we are talking about the proverbial pain cave, which we all like to discuss during an ultramarathon, when we are actually in the middle of the pain cave or afterwards over the course of a few beers as we're recollecting our races. And in order to give this concept some context, some construction and also some scientific backing on the podcast today, welcome.

Speaker 1: 1:00

Lloyd Amika, who wrote a fantastic paper that I'm sure will resonate with a lot of you listeners out there, the title of which is pushing through the pain cave lived experiences of pain tolerance in male ultramarathon runners. This is going to hit home with a lot of people. Lloyd is a referral from a previous podcast guest in this exact same area, carla Mayan, who you longtime listeners will remember. She is a two time offender of the Coupe cast, and during this podcast we really tried to give some construction, some framework around what the pain cave is, how different people experience it and how we can use those experiences in order to perpetuate performance down the road. As always, I had a lot of fun during this conversation. There'll be some links in the show notes for some additional materials that all of you guys can check out, and with that out of the way, I'm getting right out of the way. Here is my conversation with Lloyd Amika, all about the pain cave. All right. Well, welcome to the podcast of apologies for the delay on getting you scheduled here.

Speaker 1: 2:07

While my life was a little bit chaotic, I was recently at an ultra marathon this weekend Transgrang Canaria and I was reminded of the topic that we're going to discuss today, which is kind of our relationship, or, I guess, ultra runnings as a broader subject group, their relationship with the pain cave. And I was reminded of this is the woman who won this race was who's Courtney DeWalter, who's a great friend of mine. I don't coach her, but she's obviously well liked in the community. It's kind of made this one of her things right, one of her things that she kind of comes back to, as she uses this kind of colloquial terminology that you try to expand upon in this particular paper. So it's definitely relevant and something that is always the top of mind for people. Before we actually get into that too much, as I'm sure we'll bridge to it at a certain point, why don't you give the listeners a little bit of sense of what you do for a living, the types of research that you look at and what you're interested in academically?

Speaker 2: 3:01

Yeah, absolutely. So I guess a kind of very brief sort of background. So I actually am studying a marketing degree in the early 2000s and then worked in communications until around 2016. And then I kind of started the shift towards sports psychology. So firstly, kind of getting a psychology sort of generalist kind of degree, then going on to do a master's program at St Mary's University here in Twickenham in London in applied sports psychology, and then after that I went on to start my PhD, also at St Mary's University as well, and I'm currently in the second year of the doctorate program, and I guess the research that we're going to be talking about today was actually a piece of research that I worked on for my master's dissertation during the pandemic so around kind of 2021 kind of period.

Speaker 2: 4:05

So that was quite an interesting time when everybody was in lockdown, there was all sorts of uncertainty in the world, and since then I've kind of carried on down that path in terms of, you know, researching into pain, which I'll sure will kind of come to it later on. So yeah, absolutely A brief one for me.

Speaker 1: 4:26

Yeah, and this has been a revolving topic that I've had on this particular podcast and I've kind of come at it from a few different angles.

Speaker 1: 4:35

I've had neuroscientists come on and discuss our relationship with pain more from a neuroscience perspective and how the brain perceives the different signals that it's actually receiving from the body.

Speaker 1: 4:47

I've had psychologists come on and talk about the psychology of pain and our quote unquote relationship with pain and I think one of the reasons that it is so popular is because endurance athletes as a whole and I might go so far as to say ultramarathon runners in particular maybe they might be a better example of this they tend to hold in very high regard their individual and their personal relationship with pain and this part of kind of what draws them to the arduous nature of the sport and of the things that they are actually doing. I was wondering if you could kind of expand upon that before we get into this particular piece of research, if you could kind of expand on just that general cultural phenomenon right in sports in general and then maybe an endurance sports in particular and then an ultramarathon running as a final subset. Why is that relationship and that fascination with our own internalization of pain or the pain cave, or however we want to colloquially describe it. Why is it such a pervasive theme?

Speaker 2: 5:55

I think there are lots of reasons for that. I think when we look at endurance, you know, specifically there's been a lot of research that's been done within sociology and also psychology that you know actually demonstrates that pushing through pain or any sort of pain experience that you have, is quite often associated with something that's good, you know. It proves that you're training hard, it proves that something is working. And I've also seen that as well as a marathon runner myself, kind of, you know, go through training and seeing this sort of, I guess, experience of what it's like, you know, to be in pain. And I think that you know, obviously each person in endurance sport is different and they all have different experiences. But I really think that you know, pain is such a kind of universal experience that everybody goes through at some stage in their life, whether that's in sport, whether that's outside of sport, and so it's quite a personal, you know, subjective experience that can evoke a lot of different emotions for people.

Speaker 1: 7:07

And that's one of the reasons why it's I think it's also so interesting to study because of the personal relationship and it's although there have been ways to try to objectively quantify it or objectively, I guess, describe it might be a better way to put it we tend to more often fall back on some of the research which is more akin to the one that we're going to focus on today, where people just verbally describe what they're going on and we use the, we use that storyline and that dialogue to kind of paint a picture, so to speak, of what's actually going on internally, versus give us a number on the pain scale, which is a way that you can, which is a way that you can absolutely evaluate pain or effort or anything like that.

Speaker 1: 7:53

But you don't see that in other types of like experimental conditions, where you take a typical titration experiment and you say, okay, tell me the, tell me how you feel about the color blue, that this, that this substance just turned, or whatever the experiment actually is. I think the merging of both of those, where we're trying to both, both describe things subjectively and objectively, to try to bring to try to bring a different layer of context to it, I think that also adds to the, to the fascination of it as well.

Speaker 2: 8:23

Yeah, absolutely, and you know it's interesting that you mentioned about pain scales there. So you a long time at Borg's, pain scale was developed and that's something that has been a kind of scale, has been used in semi-lifthin context over the years. And yes, I think absolutely right in the sense that you know things like pain scales do have a place and they do have value, but equally, we also know as well that actually sometimes when you use those scales the context can be missing. And that's really what we kind of need as well in order to kind of, I guess, get a, a, get a a fuller picture of what's going on.

Speaker 1: 9:02

Yeah, and because of that, we tend this is going to relate to the story that I opened up with Courtney, who just happens to be kind of one of the more prolific people in the sport today that talks about her own personal pain cave a lot. One of the ways that individual athletes have relational points or points of commonality amongst each other is discussing what they have gone through during training or during a race in this subjective storytelling format versus they don't. You would, very you would, more rarely hear a runner say, oh, I was at a 10 out of 10 on my pain cave scale. More often than not, they're actually describing the pain that they were actually going through specifically, or specifically what it is, which I think also gives kind of a common bond to, to, to a lot of athletes and a lot of runners out there. The paper that we're going to discuss, I think, illustrates this really well. I'm going to read off the title and I'm going to leave it to you to kind of give the construction of what you guys were trying to accomplish.

Speaker 1: 10:09

So the title is pushing through the pain cave lived experiences and that's what I was trying to touch upon, right Lived experiences of pain tolerance and male ultramarathon runners. And it caught my eye because of a previous podcast guest that I had on here, carla Mayan, and she was a co-author in this study as well, and as I was going through it, because of all of the dialogue that you inserted into this paper. It brought me back to much of the dialogue that I have had with athletes, including at Trans Grant Canario, which I just got off the phone with one of my athletes who did that race, since I was out there, as well as just talking with people out on the race course.

Speaker 1: 10:49

So I'll turn the floor over to you to describe the study construction like how you actually orchestrated the study in the first place and then we can dive into what some of the phenomena you were able to peel out from the subjects and what some learning lessons of that might actually be.

Speaker 2: 11:06

Yeah, absolutely so. I guess the kind of starting point really is why ultra runners fast and foremost? So, really, when I was kind of doing my sort of initial reading around this subject, it became quite clear to me that the research evidence was quite limited with regards to disgusting lived experiences of pain tolerance through a qualitative lens. So there had been studies that had been done previously that were more kind of experimental studies or they were based, you know, lab based studies, and I really felt that there was something missing there. And I guess there was a kind of sense of intrigue as well, because I mentioned earlier on that I was, you know that I am a runner and I have my own sort of, you know, personal experiences of pain but also really wanted to understand actually what would it be like for the people who are running longer distances than Americans? What would their kind of pain experience be like? How might it differ from, you know, your runner or people running shorter distances than that? And so I kind of went down this sort of initial kind of rabbit hole of trying to kind of shape out what the research could be like, obviously working closely with Carla Mayan, as you mentioned earlier. And where we kind of got to is essentially a number of things. Firstly, we wanted really to kind of take a qualitative approach to explore that kind of phenomenon in more detail, but not just simply, you know, describing experiences of pain tolerance, but also trying to kind of interpret what the experiences were like, so really trying to kind of make sense of the meaning that the runners were applying to you know, lived experiences of pain tolerance.

Speaker 2: 13:09

And then, I guess, in addition to that, just to provide some clarity, because I'm sure maybe your listeners might be wondering, why did we focus on your ultra runners specifically? And again, there are a number of reasons for that. So firstly, I'm sure you're fully aware and your listeners are also fully aware, you know, there is still very much a hyper portion of male ultra runners in comparison to female ultra runners you know non-binary ultra runners, and so that was one reason. The second reason was we also knew from the recent evidence that actually males tend to experience pain in different ways to females, and so we really wanted to kind of dive in a bit deeper into what might the male kind of, you know, pain tolerance experience be like. And then the third reason, which I kind of already sort of touched upon slightly is just with regards to the limited amount of quantitative research that you know exists in this area.

Speaker 2: 14:14

Today's were some of the reasons, really, which kind of drove our decision to focus on male ultra runners. And then, in terms of the actual research itself and how we went about conducting it, did semi-structured interviews with six male ultra runners, and this was, you know, during the pandemic. So lots of kind of video calls on Zoom, interviewing runners from different age groups, different levels of experience, and these were done either a kind of like a three month period, say summer 2021. And then from there, obviously, we started to kind of get into the nuts and bolts of what was coming out of these interviews.

Speaker 1: 14:57

And, yeah, so let's make sure six male ultra marathon runners right.

Speaker 2: 15:03

Yeah.

Speaker 1: 15:03

Predominantly in interview format, where you're asking them a series of questions and you're trying to categorize the answers to a certain extent. Why don't you describe that process a little bit more, just to kind of peel the curtain back on how you academically take a conversation and start to make sense out of the data that can come out of that conversation?

Speaker 2: 15:24

Yeah, absolutely. And so basically what I did was to go through the initial kind of stage, which was essentially transcribing the data. So obviously, you know, after you've done your interview, you then sort of transcribe everything word for word. From there we started to get into the coding sort of stage, so really starting to pull out some sort of key words, key themes that were coming through. And then what I did essentially was to do that one by one.

Speaker 2: 15:59

So you start obviously from interview one and you do that right through to interview six. And then, when you do that, you then start to actually look for the themes that were coming out that were common across those six interviews, and obviously we'll talk about the themes at a later stage today. But essentially that the process that I followed in order to get to the themes, and then, as I mentioned earlier on, once you've got the themes, that's one step. But then the next thing is to really sort of actually start to think about what did the runners actually mean by the things that they said, and that's where the level of interpretation comes into play. So you're essentially kind of analyzing the data, you know, interpreting it and then trying to write what your interpretations are, the findings. I appreciate the description.

Speaker 1: 16:58

What I was trying to pull out that I think the listeners will appreciate is that, although these are conversations, there's still a systematic approach to the way that you're not only constructing the conversation, but the way that you're pulling out the information from the conversation, where you're focusing on keywords and then applying some sort of interpretation or analysis to that. It's not just picking out the things that you want to hear, right, it's a methodology to it which I think a lot of times gets lost in this type or this category of research. Cool, okay, so before we get into the themes, I want to tackle this with you, and this is it's related to the paper, but I think kind of in a tangential way. I want to get your take on.

Speaker 1: 17:40

Why do you think the metaphor is a cave? Why is it not something we could pick? Anything right, but it's always been a cave. We all grew up in sports and the metaphor has always been the pain cave, not the pain house or the pain hole or whatever. It's actually a cave. Why is that the? Why is that specifically the metaphor?

Speaker 2: 18:03

Yeah, and I have a, I guess I have a kind of thought about this, and that is that you know, when you are going through a dark moment in a race, where you're having a puzzle between your brain and your body and one of them telling you to quit, the other is telling you not to, and the puzzle goes on. The cave, obviously, is also a dark place, generally speaking, when you enter it, right. And so I guess, in a way, the metaphor cave is essentially a way of describing the fact that actually, you know you're trying to get through this dark place, mentally, physically, and you're trying to come out of that cave where you kind of, you know, find yourself, push it in through and kind of taking it on to, obviously, where you want to get, to the finish line, for example, they say, yeah, that's my thoughts.

Speaker 1: 19:06

I've postulated this on a lot of long runs and I'll ping off of that a little bit. I think a couple of the reasons that we like or people have gravitated towards this specific metaphor is the way that you could actually physically interact with the cave as well as like an actual cave, a cave in real life, compared to how you actually will encounter or react. In the pain cave metaphor you can choose to. First off it's an open-ended structure, right. One side is light and another side is dark, and you intentionally choose to go into it at some point. You don't have to right, you see a cave. You run down the trail. You see a cave. You don't have to go in there. But you can choose to go in there, just like you can choose to go into the metaphorical pain cave.

Speaker 1: 19:55

How deep you go is proportional to how dark it is. So the deeper you go into the metaphorical pain cave, the more pain you're theoretically experiencing and the deeper you're going into your real cave in real life, the darker it is, the less light will actually kind of penetrate towards your eyes. You can always turn around and you typically know the way out. So you can get so deep into your real cave or into your metaphorical pain cave, and there's nothing stopping you from turning around and walking the other way. Right, there's that element of commonality and you also don't know how deep it goes. Typically, when you're looking into a cave where you're thinking about your metaphorical pain cave, you really don't know how deep and dark it is until you actually experience it. So I think that this metaphor of an actual cave, when you think about it, it has all these experiential elements that you can translate from one situation to the other.

Speaker 1: 20:54

I'm going to bring on at some point like a caver that explores these things and see if they have the same interpretation of that. But anyway, I wanted to get your take on it as well. Let's kind of move forward to the themes, because after all of these interviews you did pick out several themes that each of the participants continually came back to and started to apply or interpret meaning into each of those themes I'll turn the floor over to you and you can take it in whatever format that you want to, from the thing that kind of impressed upon you the most to whatever. But what are some of the things that kind of stuck out to you after you digested all of the interviews and you're able to kind of see what some of these one of these more common themes actually like came out of the hopper.

Speaker 2: 21:43

Yeah.

Speaker 2: 21:43

So I guess the first thing to say is that there were four themes that came out in the research.

Speaker 2: 21:50

The first one was around building relationships and pain, and I think there was a really interesting theme for me, because you know all of the ultramarphans that were interviewed.

Speaker 2: 22:04

They were all experienced ultramarphans in the sense that they had competed in at least five ultramarphans or more.

Speaker 2: 22:13

So that was how we defined experience, and I think what was really fascinating was that actually, when they reflected on how their pain tolerance had evolved from, you know, a novice, you know beginner sort of ultra runner, to where they were that point, I think what became quite clear was that actually, the more ultra-manifest races they did, the more they found they were making this sort of physiological adaptation to the pain. It was almost like actually I know that my body is able to cope with the pain more now than I was able to when I did my first ultramar and also kind of starting to kind of pick up on those signals. So when they were in races and they found that you know that they had this kind of you know type of pain in a particular location of the body, if it was something that they were familiar with in terms of they had experienced it before in a previous race. That was almost kind of reassuring for them that actually they knew what it was all about. It was nothing to worry about. They had kind of been led before. So I thought that was really interesting to see how that kind of developed and evolved.

Speaker 1: 23:39

In other words, what you're saying is a little bit of it's not a little bit, but what they're demonstrating is the fact that it's a learned skill. Right that you can go it. You can learn about the way that you interact with pain. If you're deliberate about it, you can apply some sort of progressive overload I'm going to use training terminology here because that's my wheelhouse you can apply some sort of progressive overload so the next time you can endure more, deeper or kind of whatever vocabulary that you want to that you want to use towards it. Interestingly enough, the comment that you just made and what the participants made about when they get to a point, they can recall that they have been to a similar point before as a almost like an ergogenic trick, right, almost like a psychological trick within a race in order to perpetuate the performance.

Speaker 1: 24:31

I 100% use that with my athletes at races and in particular, with athletes who have done harder races than what they are currently in right. So if they've done some sort of ridiculously hard 100-miler and they're an easier 100-miler and that there's any easy 100-miler, I'll remind you of that in the middle of the race when they have, when they have gone through a tremendous amount of pain, and say, listen, you've been through something that's way harder than this. This is you're kind of like scratching the surface right now, and I've just found that to be very effective, which I think reinforces some of the dialogue that you're getting back from the participants as well, where they're actually able to recall those moments and kind of remind themselves that they have the experience and the fortitude to deal with whatever's in front of them.

Speaker 2: 25:16

Yeah, absolutely, and I thought you know that kind of then sort of led quite nicely into the second theme, which was what is real pain?

Speaker 2: 25:27

And that was real with, deliberately, with a kind of brackets or, if you like you know, quotes around it, because I think you know this was quite an interesting one for me and I think you know one of the things that really came out was the fact that real pain and that is the perception of the ultra runner was associated with injury or tissue damage or breakdown of some sorts.

Speaker 2: 26:00

So in other words, implying that actually, in the absence of an injury or tissue damage or breakdown, it's okay to continue, you know, pushing through the pain, right. And so I really kind of thought about this a lot, and I think something that's really interesting for me is when you look at society in general and you look at our understanding of pain, you look at the sort of images that we see around us A lot of the time. You know, pain is associated very closely with injury, and actually there was a research study done a couple of years ago by Maria Pavlova and team and what they actually showed was that, you know, pain associated with injury is far more commonly portrayed in children's TV shows in comparison to other types of pain, and so that kind of also made me think. Well, actually, maybe there's an element of us being socialized into thinking or associating pain with injury from a very young age, and maybe that kind of also, you know, shapes to a certain extent people's you know the runner's beliefs about that.

Speaker 1: 27:24

So Bugs Bunny falls off of a cliff and is stuck in a sling for the next scene with you know, daffy Doctor. However, bugs Bunny is with right and our Wiley Coyote, and we are then habituated to that, to that relationship with pain being associated with an injury and that conditioning, so to speak, bleeds into our adult lives in some way, shape or form when we're performing athletics and running and training and things like that.

Speaker 2: 27:51

Yeah, absolutely, and so I guess there's an element of that, and I think there's also, you know, an element of the culture of ultra running as well. You know I'm sure we'll talk about this a bit later on, but I think also, you know, when you have so much time training, preparing for a big race whether it's 100 miles, 24 hours or you know, whatever it is I think there's also going to be an element of, you know, risk versus reward going through your head as well. You know, the reward being that I'm going to complete this race, and is the risk worthy of the potential reward or maybe not? And I think that will also depend, obviously, a lot on each run and how they perceive their particular situation as well.

Speaker 1: 28:44

Well and you touched on that really eloquently in one section of the paper where there is a certain amount of gratification or satisfaction derived from pushing through some elements of pain, where it becomes part of the goal. We tend to think about our goal setting framework in terms of, well, I want to, you know, I want to run, you know this race and this time where I want to get XYZ place or I want to get the big belt buckle versus the small belt buckle or whatever. But there is gratification and satisfaction from other aspects, other experiential aspects of both racing and training, and one that this paper touched on was the gratification that somebody can receive or that somebody can earn I guess is a better word earn from pushing through the pain.

Speaker 2: 29:33

Yeah, absolutely, and I think that you could even break that down further. So there's the instant gratification during the race itself, and then there's the delayed gratification. So if you take the instant gratification first, you know you may, for example, discover in a race that you're able to push beyond the point that you hadn't anticipated before, and so you get sort of instant gratification. And then the delayed gratification really comes at the end of the race, and that's not just gratification in terms of how you feel internally about the fact that you've crossed the finish line, but also the relational aspect as well. So you know the people around you, the other runners in the community, not just the race, but also in an online, like a digital space as well. You know the kind of kudos that you know you might get from your peers, or the bragging rights, so to speak, and so there's kind of things as well can also be an influencing in deciding to push through the pain during the race.

Speaker 1: 30:49

And it's also a factor on the other side of it, which came out in a couple of the pieces of dialogue that are in the paper having to endure or encounter some degree of pain at some point of a race and in particular at a point in the race that would be earlier than what is anticipated at times, at least according to some of the dialogue that I'm reading here and I'm kind of reading through the tea leaves a little bit so.

Speaker 1: 31:16

So please feel free to correct me if I'm making too big of a leap, but encountering that, that that pain earlier than anticipated, seems to trigger an internal dialogue to start to consider to, to discontinue the race right to DNF the race because it's either unanticipated or they don't know if they can deal with whatever they're going to, whatever pain level that they're going to theoretically tolerate later on in the race. I was wondering if you could kind of expand upon that relationship, because at one point where there's gratification for encountering it, there's also this other kind of. It's literally an other side of the coin where you encounter it and it starts to induce a kind of a negative thought process or cycle.

Speaker 2: 31:59

Yeah, so one of the participants in the study did talk about how the sort of state of the race that you're at can influence your decision on whether you choose to to push through the pain or maybe, you know, decide to withdraw, and maybe that's what you're referring to, because I think that you know, to give you an example, you know if you're in a hundred mile race and you're kind of getting through that, you know pain came, say, to speak at mile 60, you know you'll probably have a quite a different sort of thought process to that was happening mile 20, for example, where you're obviously further away from the finish line than you know where you would be at mile 60.

Speaker 2: 32:51

So I think, yes, absolutely, and we'll come onto it fairly shortly there is a, there is definitely a negative aspect, not always, and it wasn't for every single participant, but there were certainly a few who had some negative consequences as a result of pushing through pain when maybe on that particular day they would have been wiser to not continue. But I also think as well and it's a slightly gain on a tangent but you know, I do think that even though DNF is essentially, I think it has a much deeper meaning than that for a lot of runners and when they think of DNF they sometimes think of failure. They don't want to let themselves down or they might feel that they're letting other people down or their coach down, and I think sometimes it is hard to kind of accept that. Actually, you know what a DNF isn't necessarily a bad thing. You know you'll get other chances to race again. I think that's definitely something I've also thought about as well is the meaning behind DNF for people.

Speaker 1: 34:13

But you know this is reminding me one of the more difficult answers that I have to articulate to a really common question that I get is how much pain is an acceptable level of pain to push through in a race? And to back that up a little bit, I think the person asking that question they have come to the understanding that it's part of the gig, it's just part of the nature of getting into a big, arduous race is that they're going to have to deal with some level of pain and or discomfort. So they've kind of got. They're not naive in the fact that you know they're not. This isn't all sunshine and rainbows and gummy bears. This is going to be. This is going to be difficult and at times painful.

Speaker 1: 34:59

But as a coach I've always had an extremely difficult time trying to articulate that answer and especially when I've been in, when I've been in a forum where there's a lot of people and I've had to stylize the answer across people, athletes that I work with, athletes that I've never met before, coaches that are in the room and things like that.

Speaker 1: 35:20

And I was wondering if you could elaborate a little bit more on that concept of is there a way that athletes can start to internalize how much pain they should be willing to or should have to go through during a race, or what things should they take into consideration when they're making that own self assessment for them as an individual, which might be the more kind of like pertinent part of it and, like I said, I just want to kind of come back to. I think that this is a common thing that a lot of ultra runner struggle with, because they get it, they're not naive, they understand that it's part of the gig, but they struggle with what like how much is too much and how much is that going to be deleterious long term?

Speaker 1: 36:10

Sure.

Speaker 2: 36:12

I think there's a couple of points to that. So the first thing I would say is, if we go back to that first theme that we talked about, so the building relationships with pain theme and we talked about ultra runners recognizing pain right that they had experienced before during that kind of process, when they were becoming more experienced ultra runners and I do think that if an ultra runner experiences pain that they are not familiar with, they've never experienced it before, or maybe the pain is more severe than what they have previously experienced, that in itself can sometimes be a signal of okay, something's not quite right here. What do I do? And maybe you know, you try and get to an aid station and you get it checked out and the you know they source of things.

Speaker 2: 37:07

But also there's another point as well, which is in the lead up to the race itself how are you feeling? You know, are you carrying any niggles? Are you carrying any sort of injuries? Are you essentially already kind of entering that sort of risk kind of game, if you like, prior to the race itself starting? And if, say, for example, you have been experiencing pain for a while, you haven't had it checked out and maybe you've got some niggles or an injury of some sorts, and it's getting close to the race day itself, then I think you know it's perfectly normal and valid for someone to ask themselves, actually is this worth the risk? Or, if they're being coached by somebody you know, speak to your coach and say, look, you know what do you think? If it's too risky, do I sort of, you know, withdraw before the race actually kind of gets going, or do I take a chance and see how it goes and maybe kind of see how things net out? So there's a couple of thoughts that I have.

Speaker 1: 38:24

You know it's interesting to towards your last point of risk E in my caveman coaching type attempts at articulating an answer to that's. Typically, the thing that I will lean on the most is what is the risk value proposition for you as an individual? Are you okay with going big or going home? And if you're okay with that, then you come into an aid station and you're experiencing some weird pain. You're going to lean more towards suck it up and keep going down the trail versus I need to get this evaluated and I got to have to rethink my whole game plan or whatever. If you don't have a very high appetite for for risk, then that proposition is much different. You're going to be more conservative when you're evaluating those things going on, you come into an aid station with the exact same sensation. It could be much easier to pull the plug in DNF. That's.

Speaker 1: 39:19

I'm not going to say that's the only way that I try to help people work through that, but that's the predominant tool in my toolkit that I would use is try to come up with, try to help the athlete formulate how, what their relationship is with that risk taking proposition and really what's within their value set, so that the decision that they have to make in real time is congruent with the decision that they have made in advance, when they have more clarity and more time to process it.

Speaker 1: 39:51

Because in a race, even though these are low intensity, long duration activities and we like to think that there's a lot of time to think about things those are not easy decisions to make because you're fatigued in your, your resources or compromise. Certainly your intellectual faculty and things like that are certainly compromised during the race, and coming up with this perfect answer not that there ever is one is definitely hindered by the conditions of the race that you're that you're experiencing. So, anyway, my point with that is is just interesting to hear you mentioned this risk component. That might be some piece of differentiation that that people can apply when they're trying to determine how much pain that they are willing to endure.

Speaker 2: 40:30

I think that's another point as well, and, you know, maybe this is something you've also seen. But certainly something that I picked up on from the research was the desire to always kind of seek out longer distances. And it's, you know, you do a 50 mile run and you're really happy, and then you go online other runners oh, they've done 100 miles, they've done 150 miles. And then you think, oh, actually you know what, I need to do 100 miles next time rather than stick 50 miles. And I do sometimes wonder whether you know, taking that approach, where you know you're always seeking to kind of run longer distances, I wonder whether the body has enough time to physically adapt to the challenges within a particular distance before you then jump to the next one, and the next one, and the next one. I mean, where does it stop? Right? You know it's.

Speaker 1: 41:32

Here's the. We're going to go off the rails a little bit here, but it's my podcast, so I can go on whatever rail I want to. I noticed the same thing People tend to go up in distance as a way to challenge themselves, and that's not the only direction. Right, you can challenge yourself differently at the same distance or even go down in distance. But I think that because of this really unique phenomenon in ultra running, where there's a very big gap between your longest training activity and the race, which doesn't really exist at the marathon distance, right, you go and train for a marathon, everybody doesn't you know 18 mile long run or 20 mile long run or whatever. So your gap between the longest training activity and the race is something that you can easily conceptualize. Right, it's 10 kilometers, you know eight miles, something like that, something that you can kind of easily wrap your head around. Okay, I did my long run here. I've got this much further to go.

Speaker 1: 42:30

I can picture that that doesn't exist in ultra running and I think that's an attractive it may be at a sub conscious level an attractive point to a lot of people who are in ultra running. Hey, it can only go 30 miles in training. So I'm going to do a hundred mile race. That unknown of 70 miles is actually an attractive quality of the event itself.

Speaker 1: 42:52

And being that it's an attractive quality of the event itself, the way to enhance or to kind of perpetuate the continual adaptive nature that we are all craving is to continually increase that gap, right?

Speaker 1: 43:07

So at first it's, you know, 30 miles to 100 miles, so 70 miles is the gap. And then it's 40 miles to 200 miles, which then it's 160 miles is the gap, and you can apply any sort of like mathematical equation to that that you actually want to. But I honestly think that seeing this phenomenon and I absolutely see this in the marketplace and I see this as a coach that people want to challenge themselves and the then or the conduit of the challenge is duration, it's not intensity. It's not nearly as common to challenge through the conduit of intensity, it's way more common to challenge through this conduit of duration. I think that some of this is the, this phenomenon of the unknown that people just have a craving for and they're attracted to it, and that's why we see this phenomenon of going up in distance way more often than we see it going down in distance.

Speaker 2: 44:02

Yeah, yeah, no, it is really fascinating. I think that each ultra runner needs to ask themselves what's my threshold right, when do I stop? And we have one participant in the study who was running 50 mile ultra races. He then sort of went to 100 miles, realized that actually he didn't really enjoy that and then went down to 50 miles Too much. And with that I think sometimes you may be by default you can also realize that actually this isn't for me and I need to focus on something shorter, which doesn't mean that you're less of an ultra runner Exactly, it's just that's what you prefer to kind of do. Yeah.

Speaker 1: 44:50

Okay, I want to start to drill this down to things that athletes can take away that will make them better runners.

Speaker 1: 44:57

You know, not everything that we explore in this podcast is an intervention. Right, I'm going to take XYZ supplement or I'm going to do this type of interval in order to make myself better. A lot of times it's just the knowledge framework that makes you a better athlete, a better person, more capable of handling an ultra marathon or whatever athletic endeavor you're doing, just by kind of knowing more about the different phenomenon that are going on during the race itself. So I was wondering if there's anything in particular that stuck out to you in the research that somebody who's listening to this, just by knowing it, would have a little bit of an advantage out there on the race course just by knowing that little tidbit of information, or that somebody has experienced something similar based on the surveys that you've been doing, that they can kind of take away from a functional standpoint and go. You know what? I'm a better, I could possibly be a better runner through now, having known this.

Speaker 2: 45:55

Yeah. So I guess you know thinking about it obviously from a pain context, there's a number of things that I think could be really helpful. The first one is actually really about talking about your pain with your peers and your coach. If you are being coached, you know, is there a dominant narrative around that? How comfortable do you feel talking about it or seeking help if you need it? And you know, really kind of taking the time to kind of reflect on that as well in terms of how do I feel about pain and what is the negative within the environment that I find myself in whether it's in a club, whether it's in another type of space and really trying to kind of, you know, drill down into that.

Speaker 2: 46:46

And then there's another point, really, which is very much around when you start to experience pain in any way, shape or form and feels like a niggle, or it feels like something that you know potentially could manifest into something else, I always think, from a prevention perspective, it's better to get on top of it as early as possible. So if it's something that's bothering you a little bit, rather than trying to push through the pain and just carry on with your training as normal or you know your race as normal, take a bit of time out, go and get it checked out with a specialist, you know a physical therapist or you know whoever, just to make sure that everything is okay with. There's something to worry about, then at least you can try and, you know, get onto it first hand. So those would be two starting points. I'll take a pause there in case you want to ask any questions around that.

Speaker 1: 47:50

I mean, actually that's perfect.

Speaker 1: 47:51

Those are two, I think, particularly with the first one being I kind of went back to, I kind of started this with not everything has to be an intervention.

Speaker 1: 48:00

You can actually view that as an intervention every week or twice a week.

Speaker 1: 48:04

I'm going to talk about, you know, how I experienced pain during this workout with my training partner or my coach, some, somebody that can actually be a sounding board, because I keep coming back to this, the more and more I explore it is that it's just as much of a learned skill as any other skill that we see in sport, whether that's learning how to kick a soccer ball or shoot a free throw or any any prototypical skill that we think about.

Speaker 1: 48:31

Learning how to manage your relationship with pain and how to push yourself and how to understand the, understand the signals that your body is, that is, that your body is relaying to your brain is just as much, or can be just as much, of a home skill as anything else if you give the space to actually hone it. So you wouldn't be able to shoot a free throw if you've never picked up a basketball instead of the free throw line and shot that free throw hundreds and hundreds of times. Similarly, you don't expect to have a accurate representation or accurate interpretation of the pain that's coursing through your body unless you take the time to intellectualize it, process it and discuss it with others.

Speaker 1: 49:13

That's the way that I've always kind of viewed this learned skill aspect Cool. Okay, yeah, let me ask you to kind of like sum up with where what's going to be like. Where do you want to take the future of this? You know you've had some initial research on and you're obviously not the first and the only person to explore this. There's a I think that there's actually a robust community of researchers that are trying to, that are trying to describe this phenomenon within particularly athletic populations, but other populations as well. Where do you want to see it go after this initial dive into it?

Speaker 2: 49:48

Yeah, so I mentioned right at the beginning that I'm in the second year of my doctorate program at St Mary's University and what I'm doing currently is actually exploring and Looking into chronic pain within endurance sports.

Speaker 2: 50:06

Say that would of course, include ultra running, but it also includes other types of endurance sports as well triathlon, cycling, etc. And my kind of interest there is. I think it's fair to say that if you look at most of the sort of developed nations so if you think of the US, you think of the UK, Australia, for example, I think it's something like one in four or one in five people in those countries who live with chronic pain. Right, so it's obviously a huge priority in terms of public health. But then when you throw that down into the endurance sports or the landscape, the evidence is less clear. However, we know anecdotally, even just from hearing from elite athletes, that they are and have lived with chronic pain, and therefore I think it's definitely an area that warrant more research, to kind of understand more about perceptions, experiences of chronic pain, how that might differ across different endurance sports as well. So that's just a flavor of where my research is headed, sort of at the moment.

Speaker 1: 51:30

It's an interesting intersection because I touched on this theme earlier. Athletes kind of accept the fact that living with some level of pain or discomfort is part of the gig. It's going to be part of whatever they live with, because the training is supposed to be hard and in order to improve you got to get worse before you get better. And part of that getting worse part is you tear your muscles apart and they have to rebuild and tear other structures apart in a healthy way, obviously.

Speaker 1: 52:05

But if there is a line of demarcation and it's probably not it's probably a very gray area. If there's some sort of line of demarcation or gray area between the pain that can ultimately be productive and the pain that is counterproductive, it's hard to discern because you have an audience that's willing to, partially because you have an audience that's willing to accept it. Then you combine that with the fact that let's just face it endurance athletes are always injured and part of that injury process is recognizing the pain signals that could potentially be a warning sign for potential injury. So I have no doubt at all that you're going to have a robust cohort of people to draw from because of all these. If anybody wants to sign up for any of this research, lloyd, how can they find out more about it or actually get a hold of you to learn more?

Speaker 2: 53:02

Yeah, absolutely so. They can contact me via email and I'll share my link with you afterwards, which you can click on your show notes. You can also follow me on Twitter as well. It's Nathan78, and I'll share the handle with you as well, jason, afterwards, I'd say they're probably the two best ways of finding me. I'm on LinkedIn as well, but I would say probably email are the best ways of getting in contact with me.

Speaker 1: 53:37

Awesome Good job at using the updated app main X as opposed to Twitter. It's about 50-50 now. Maybe a couple years from now we'll get to 75-25. Everybody will come into the modern area.

Speaker 1: 53:48

Anyway, I really appreciate your work. Like I said, this has been something that I've explored several times on this podcast. It's something that's personally very fascinating to me. It's relevant to me both as a coach and an athlete and to the audience. Anytime I put up something about our relationship with pain or the brain or anything like that, it ends up being quite a popular episode, I think for a very good reason. I'm very appreciative of your research. Links to everything will be in the show notes. I hope some people get ahold of you after this podcast. Once again, I appreciate your time.

Speaker 2: 54:21

Cool, give it a big mouse. Jason, it's so happy to be on the show.

Speaker 1: 54:26

All right, folks, there you have it. There you go. Much thanks to Lloyd for coming on the podcast today and giving up some framework and some context to work with this colloquial and metaphorical pain cave that we all encounter and really have to work with and work through as we are training and competing for these ultra marathon events. As we were discussing this topic, I really came away with two big highlights, the first of which is if you want to have better identification with the pain that you're going to inevitably endure, a great piece of framework for that is to just simply talk about it. You can recall this in a journal or in your training log. You can discuss it with your coach or with your training partners. Somehow verbalizing it and putting context to it after you have experienced being in the pain caves gives you a better ability when you are, when you have to visit it in the future, to recall those memories as something that you could actually deal with, and if it's something that you didn't deal with very well, it also gives you context of how you can course correct that in the future. The second takeaway that I that I came away with after this podcast was there's a difference between pain associated with just competing and pushing ourselves in ultra marathons and the pain associated with injuries, and we should learn to differentiate between the two, and in many cases, athletes are actually quite adept at creating that separation between those two different points of pain.

Speaker 1: 55:58

Links to all the discussion points will be in the show notes. I hope you guys check that out. As always, I appreciate the heck out of each and every one of you listeners out there. If you want to support this podcast, all you have to do is just share it with your friends and your training partners. There is no better way to share the love of the information that is contained within this podcast by just simply passing it along to other athletes. All right, folks, that is it for today and, as always, we will see you out on the trails.