by Jennifer Bennett Ziegler
A person’s experience of pain is influenced by a complex matrix of physical, social and psychological factors. This paper does not encompass a complete review of the many types of pain, or the many varying factors involved in pain and pain management. In general, this paper does not address the chronic pain population, but rather, those with acute pain that has an identifiable physical cause unrelated to a chronic disease process, such as cancer or colitis, or pain that is complicated by severe psychological factors, such as PTSD. For the most part, the pain and associated factors addressed herein pertain to the average person who has no chronic physical or clinical psychological circumstances.
Any kind of physical training – be
it running, weight-lifting, rowing, boxing, gymnastics,
or martial arts – involves pain. The human body is a
remarkable and wondrous thing. From devastating war
wounds, the ravages of disease, any number of horrific
accidents, childbirth, bombings, violent assaults, to
stunts gone wrong, the human body has the capability of
enduring and recovering. More important, the human brain
has the ability to deal with the resulting pain.
Sometimes, this ability seems impossible, mysterious, or
magical. This paper generates the hypothesis that a
person’s experience of pain is a determining factor in
who quits and who continues.
Pain
is a necessary sense and vital to survival. Pain alerts
us that something is wrong. Pain can be a warning signal
(Don’t touch that stove!), an indicator of disease (That
tender abdomen could be a sign of appendicitis.), or
tissue damage (Get that knee checked!). So, what makes
people willingly undertake and continue with training
that hurts? Do these individuals have a higher pain
tolerance than others? What makes roughly 70% of the
people who come into a dojo and begin training quit in
less than six months (Rates of Attrition 1)?
Do these people have a lower pain threshold? Is pain
tolerance the best indicator of performance?
Medical pain is defined by the Merriam-Webster Online
dictionary as
a : a state of physical, emotional, or mental lack of
well-being or physical, emotional, or mental uneasiness
that ranges from mild discomfort or dull distress to
acute often unbearable agony, may be generalized or
localized, and is the consequence of being injured or
hurt physically or mentally or of some derangement of or
lack of equilibrium in the physical or mental functions
(as through disease), and that usually produces a
reaction of wanting to avoid, escape, or destroy the
causative factor and its effects
b : a basic bodily sensation that is induced by a
noxious stimulus, is received by naked nerve endings, is
characterized by physical discomfort (as pricking,
throbbing, or aching), and typically leads to evasive
action
Pain can be categorized in
a number of ways. One way is to classify pain by acute
pain or chronic pain. Acute pain generally has a quick
onset and is sharp in nature. The pain may be slight and
short-lived, or it may be severe and last days, weeks,
or a few months. Acute pain usually indicates an injury
or threat to the body and is resolved with an escape
from a painful stimulus, or a successful treatment of
the underlying cause, as in the healing of a broken
bone. Chronic pain, however, is pain (sharp or dull)
that lasts longer than three months and is present even
after an injury has healed, or without any indication of
a past injury or evidence of damage (Brannon 161). There
also are ways to classify pain by cause: tissue damage
(nociception), nerve damage (neuropathic pain), and
psychogenic pain (pain affected by psychological
factors) ("Pain Classifications"). The type of tissue
affected can also be used to classify pain, i.e., back
pain, joint pain, myofascial pain ("Pain
Classifications").
No matter how
you identify it, pain is a very subjective experience
(Tracey 377). There are many factors that influence how
an individual interprets and reacts to pain. Several
studies have indicated that negative emotions (anger,
anxiety, and depression) correlate to increased
perception of pain and the likelihood that an
individual’s acute pain will transition into chronic
pain (Robinson 77). Coping strategies also greatly
affect an individual’s perception, and therefore
tolerance, of pain. Catastrophizing ("This is the worst
thing that’s ever happened to me"), hoping ("I have
faith that someday doctors will find a cure for my
pain."), and invalidation of pain ("This isn’t really
pain; it’s just a dull ache.") generally have a negative
effect (Boothby 349 – 353). Ignoring the pain or
diverting attention with passive activities like reading
a book have little influence or inconsistent results in
the perception and tolerance of pain. However, people
who received instruction on distraction or sensation
monitoring, those who used positive coping
self-statements and those who exercised regularly
exhibited a higher pain tolerance and generally
recovered from their pain condition (Boothby 349 – 353).
However, one of the most interesting findings,
especially for the scope of this paper, is regarding
appraisal properties.
Primary
appraisals…are those relating to judgments about whether
a potential [pain] stressor is irrelevant,
benign-positive, or stressful… stressful appraisals
[are] those that suggest the event poses a threat, those
that suggest the event poses a challenge, or those that
suggest the event will result in possible harm or loss.
Appraisals regarding potential harm produce negative
emotions, such a fear and anxiety, whereas those
focusing on the challenging aspects of the event(s)
might produce feelings of eagerness or excitement,
particularly when the person believes that positive
coping skills are possible…Finally, coping
responses…ultimately influence important adaptational
outcomes, such as social functioning, morale and somatic
health (Boothby 344).
Those
undertaking a physical activity with any seriousness are
likely to suffer intense acute pain at the onset –
muscle soreness and joint pain. As training continues
and intensity increases, tendon, ligament or joint
damage can (and sometimes do) occur, even among the most
careful athletes. As a result, pain can be a powerful
deterrent. Many do not continue with any activity that
results in pain. Though every one of the world’s
greatest athletes started out as everyone else does – at
the beginning, as amateurs.
Interest, desire, time,
financial resources, and natural ability can account for
the success of many, as does an ability to control and
manage pain. Olympians are some of the best trained
athletes on the planet. All of them are in amazing
physical condition. But, being so doesn’t necessarily
immunize them against a painful injury that keeps them
from performing. Most athletes at this level have had
multiple injuries, some very severe and which required,
sometimes, a year or more of recovery. Yet, once they
heal, they continue to pursue their training. How do
they do this? It’s not merely the fact that they are in
good physical condition or that they possess a magical
and unattainable pain threshold. Those things certainly
help, but when you are in the sphere of Olympians and
career sportswomen and men, body type, natural ability,
drive and a tolerance for the rigors of training far
exceed the average.
What about the
average, but dedicated, runner, swimmer, or martial
artist? What about female college student Bobbi Gibb who
trained for and completed the Boston Marathon, despite
being raised with the belief that running more than a
mile-and-a-half was deadly to women (Binkowski)? What
about regular kid, Bill Kirby, who endured glandular
fever and numerous failings to become the fourth fastest
swimmer in his home continent of Australia (Townsend)?
What about the people who actually stick it out in
dojos, dojangs, and kwoons? What makes them come back
time and again after sustaining multiple contusions,
broken fingers and toes, torn muscles, sprained limbs,
and even major knee and shoulder surgeries? It’s not
just pain tolerance.
In the 1968
Summer Olympics in Mexico City, world-record-holding
American runner Jim Ryun was favored to win the
1500-meter race. Kipchoge Keino, a police officer from
Kenya, was one of his opponents. A few days before this
race, Keino collapsed during another race, was rushed to
the hospital and diagnosed with a gall bladder
infection, which is extremely painful, especially when
taking the deep breaths needed for running. He also was
told by the doctor that if he ran the 1500 he could die
("How One Kenyan Tribe…"). Keino ran it anyway.
At the start of the Olympic 1500, Keino was dead last.
After the first lap, he was third and after the third
lap, he was first ("Keino v. Ryun"). This didn’t bother
Jim Ryun, because he was famous for his "kick," adding a
burst of speed at the very end of the race ("How One
Kenyan Tribe…"). In the last lap, Ryun employs his kick.
Kip Keino is in the lead and must have been in pain due
to his gall bladder infection diagnosis a few days
prior. But he did not slow down. Despite Ryun’s best
efforts, Keino wins gold ("How One Kenyan Tribe…"). Not
only did he win the gold, he set the Olympic world
record and won by 20 meters, "the widest margin of
victory in that event in Olympic history" (Rhoden).
Since the 1968 Summer Olympics, Americans have
associated Kenyans with being good runners. However, it
is not Kenyans, in general, but a specific tribe in
Kenya – the Kalenjin – that excel in running ("How One
Kenyan Tribe…"). The Kalenjin number approximately five
million, which makes them a minority even in Kenya, out
of a total population of around 44 million. This makes
them a significant minority on a global scale – yet they
dominate the world’s long-distance marathons. For
example, Wilson Kipsang won the 2013 Berlin Marathon
with a time of 2 hours, 3 minutes, and 23 seconds, the
fastest marathon time ever recorded ("How One Kenyan
Tribe…"). A few weeks later at a race in Chicago, Dennis
Kimetto broke the course record there, even though he
had only been training for four years. Consider this:
seventeen American men in history have run marathons in
under 2:10. In a single month, October 2011, 32 Kalenjin
runners clocked marathon times of under 2:10 ("How One
Kenyan Tribe…").
In his book, The
Sports Gene, David Epstein attempts to explain this
phenomenon. The Kalenjin live at high altitude, have a
high-starch diet and run to school. Additionally, the
annual salary of a runner is attractive for rural
Kenyans – ten to twenty thousand dollars. Epstein points
out, however, that these factors are not unique to the
Kalenjin tribe. Lots of people all over the world live
at altitude, eat high-starch foods, run to school and
could use some extra money – yet they don’t come close
to the dominance of the Kalenjins in long-distance
running ("How One Kenyan Tribe…"). The Kalenjin also
possess certain physical characteristics that give them
an advantage when running, such as long, slender limbs
with very thin ankles and wrists ("How One Kenyan
Tribe…"). Even taking into account these biological
advantages, Epstein asserts that "there is not a single
sports gene that ensures success." There is something to
performance and ability that "scientists haven’t found a
gene for – a mental ability to persevere through
unimaginable pain" ("How One Kenyan Tribe…").
There is, however, one thing that is unique to the
Kalenjin experience that highlights how they approach
pain. They have an initiation ceremony, a rite of
passage that all Kalenjin teens – girls and boys – must
go through. The successful completion of this ritual
means that the teen is accepted as a full member of the
community. As such, the teens become adults and are able
to date, select a partner, marry and begin a family.
Failure to complete this ceremony earns one the label of
"coward" and essentially results in being ostracized by
the entire tribe. The ceremony is one that tests the
limits of the human body to endure terrible pain ("How
One Kenyan Tribe…").
The first
part of the ceremony involves crawling, mostly naked,
through a tunnel of African stinging nettles. Next, the
teens are beaten on the bony parts of the ankle and
their knuckles are squeezed together. Acid from the
nettles are wiped onto the genitals of the teens and,
early one morning, the girls undergo genital mutilation
and the boys are circumcised with a sharpened stick.
After this, they are taken away from the village to
separate huts to heal for, at most, a day or two. They
are told when they leave the hut, they may no longer
walk. They must run everywhere. The most significant
requirement of the entire ritual is that at no point may
the teens show any signs of pain. They may not grimace,
clench their teeth, twitch a muscle or utter a sound. In
some cases, mud is caked onto the faces of the girls and
boys and if a crack appears in the mud, the teen may not
become a full woman or man ("How One Kenyan Tribe…").
This ritual is just a ceremony, but it is reflective of
a communal attitude toward pain.
It is this ability, Epstein believes, to endure extreme
pain with stoicism that gives the Kalenjin an edge in
the distance-running department ("How One Kenyan
Tribe…"). While this ritual certainly gives a forum for
the Kalenjin to learn how to endure, this ability is not
magic. It also is not reserved only for the Kalenjin
tribe, elite athletes, or Zen masters. Regular people
can develop this ability and learn ways to mitigate and
manage pain. These regular people are the Bobbi Gibbs
and Bill Kirbys of the world. These people are the ones
who don’t quit their practice within six months, not
because it doesn’t hurt them, but because they can or
have learned to deal with pain in productive ways. And
they do so even if they don’t realize they are doing it.
Angela L. Duckworth, Ph.D. studies "grit psychology."
Her term, grit, is defined as "perseverance and passion
for long-term goals" (Duckworth 1087 – 1088). She
further details that grit entails working strenuously
toward challenges, maintaining effort and interest over
years despite failure, adversity, and plateaus in
progress. The gritty individual approaches achievement
as a marathon; his or her advantage is stamina. Whereas
disappointment or boredom signals to others that it is
time to change trajectory and cut losses, the gritty
individual stays the course (Duckworth 1088).
Dr. Duckworth and her colleagues developed the Grit
Scale (Duckworth 1089). Their research found that
academic performance is influenced more by grit than by
IQ; and those with a lower IQ, but more grit, performed
better than those with a higher IQ, but less grit
(Duckworth 1093). The team wanted to further test their
findings on people who undertake an extremely rigorous
and challenging path. So, they applied the Grit Scale to
freshman cadets entering West Point Military Training
Academy (Duckworth 1094).
Acceptance into West Point
is extremely competitive and the military already has
extremely high standards for applicants, such as high
SAT scores, leadership ability, past performance and
physical ability (Duckworth 1094). Even so, one out of
twenty cadets quits during the first few months of
training (Duckworth 1094). Dr. Duckworth and her
colleagues wanted to see if their Grit Scale would be a
better predictor of retention than other factors
(Duckworth 1094). Her team found that "grittier
candidates were more likely to complete their first
summer of training at West Point" (Duckworth 1096).
Further, "grit predicted completion of the rigorous
summer training program better than any other predictor
(Duckworth 1095).
As mentioned
previously, coping strategies and primary appraisals are
important factors in how one interprets pain. A person
who associates pain with negative feelings ("Not again!"
or "This is just like last time.") will be more likely
to succumb to pain than a person who associates pain
(like the Kalenjin) with positive feelings ("This will
make me a woman/man!")
Those whose
primary appraisal of pain is irrelevant or
benign-positive were better at managing pain than those
who appraised pain as a stressor. For example, a woman
going through labor who views her pain as a means to
deliver a healthy child will interpret her pain as more
manageable than a woman who views the pain as pain,
without a thought to the necessity of it. Additionally,
those who view pain as a potential for harm rather than
a challenge will interpret their pain as less manageable
and will be more likely to avoid painful activities
(Boothby 344).
Hypnosis2 has
been used (at least in Western medicine) to control pain
since WWII (Syrjala 189). "Hypnosis and imagery are
generally agreed to be states of highly focused
attention during which alteration of awareness,
sensations, and the affective response to perceptions
occur" (Syrjala 187). Hypotheses vary as to why hypnosis
is effective in pain control, but it is generally
thought "to reduce pain by mechanisms including
attention control and dissociation…" (Syrjala 187).
Changes in blood flow and electrical activity along
spinal pathways have been observed during hypnosis,
which support the hypothesis that hypnosis is associated
with altered consciousness (Syrjala 187). Through
hypnosis, someone in pain can try several strategies to
mitigate or eliminate pain. The most common are to
imagine walking down a path away from the pain, focusing
on acknowledging and exploring the pain, and imagining
the pain as a bright color then fades, or a high
temperature, which cools (Syrjala 199). Each individual
has different images or suggestions that are most
effective with her or his individual practice of
hypnosis and finding the right ones increase the
effectiveness of pain control (Femhi 68 – 73). Hypnosis
spectrum activities provide an example of how our
actions can mold our experience of pain.
Consider the Kalenjin tribe. All of its members expect
an extremely painful coming-of-age ceremony. They view
the ceremony as an important and necessary test. They
are highly motivated to successfully complete the ritual
to avoid public shame. They have witnessed many of their
fellow tribe members go through the ceremony and so
learn that it is within their control to complete. And
perhaps most important, the Kalenjin are able to see
past the short-term pain to the long-term benefit –
becoming full women and men. These mental strategies
carry over into their performance in running. They have
developed, consciously or not, positive primary
appraisals of pain, as well as effective coping
strategies to deal with it.
In light of the
information presented thus far, we can assert that pain
tolerance is not just a physical characteristic or a
genetic anomaly, but rather a mental skill that appears
mysterious and magical, yet is explainable and
attainable. It can be acquired by experiences imposed on
us, as with the Kalenjin ritual, or it can be acquired
by simply seeking out a hypnotherapist.
Also, pain tolerance in and of itself is not the only
factor that predicts a person’s willingness and ability
to continue along a path of resistance. "Grit," too,
appears to be an extremely helpful characteristic needed
to endure in the face of extremely challenging
conditions. In the example of the West Point cadets,
something more than physical and intellectual ability
(or even pain tolerance) is required. Duckworth believes
that "grit" can be taught, and is currently working on
ways to develop a systematic way to do that, especially
among children (Winerman 31).
It
is these characteristics, the mental ability to
effectively deal with pain -- the mindset -- and the
"grit," -- the fortitude -- that high performers have in
common. It is these traits that give the average person
the ability to keep training, even if and when it hurts.
It is the lack thereof that determines who will quit at
the first aching muscle. This mindset is learned in our
own dojo and is taught to every beginner if she or he
has the capability to see past the pain to an attainable
goal. It is taught and learned whether the student
realizes it, or not. The act of coming to the dojo,
checking ego at the door, bowing in to a sacred space,
changing out of street clothes and then taking
chudan-gamae are the first steps to developing this
mindset. And developing this mindset is the first step
to being able to give the blood, sweat and tears
required for the job of becoming more.
It’s not magic. It’s not a mystery. It’s just mindset.
Notes
1 Rates of
Attrition for Itten Dojo for the time period of 2008 –
April 2014. Analysis received by this author on 13 April
2014 via email. Statistics compiled by Robert E. Wolfe,
II show that 38% of new members quit within three months
and 68% quit within six months.
2 In
this paper, hypnosis refers to hypnosis with or without
imagery, as well as self-hypnosis or hypnosis that is
guided by a trained clinician.
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