In the first installment of a swimmer’s guide to pain, we discussed basic concepts of pain for swimmers. That piece addressed the neurological basis for pain, suggesting that much of how we feel pain relates to how the nervous system perceives an external threat.”Perception is key, not merely structural damage, as many studies have shown that pain-free subjects can have structural damage in similar rates to painful subjects, particularly for repetitive use conditions. Each swimmer’s sensitivity is driven by a myriad of factors such as previous injury, personality, training load, stroke biomechanics, among other factors.”There’s another dimension to pain that we did not discuss in that first installment. I’m not talking about injury but rather the healthy type of pain we all feel with the exertion of a hard set or during any race. Pain is inevitable in high-level swimming, but certain questions remain…
Is pain tolerance trainable? Can pain threshold be raised? What determines a swimmer’s ability to deal with pain?
First, it’s important to arrive at working definitions. Pain threshold (for our purposes) refers to the level at which the swimmer begins to feel discomfort or pain. Pain tolerance is the ability of the swimmer to endure prolonged exposure to pain. Now, these aren’t totally independent concepts, but terminology is often confused.
One recent study (Jones 2014) addressed whether chronic exercise can increase pain tolerance and pain threshold. The experimental group in this study undertook a formal exercise program while the control group did not. “Significant increases in aerobic fitness and ischemic pain tolerance were seen in the exercise group after training, whereas pressure pain threshold and pain ratings during ischemia were unchanged. No change in aerobic fitness or pain sensitivity was observed in the control group.”
Compared to the control group, the exercise group improved pain tolerance but not pain threshold. To most readers, this should make sense intuitively as athletes tend to be more comfortable with physical exertion than non-athletes. But what does this study tell us about differentiating between athletes? Unfortunately, it is difficult to draw conclusions with a homogenous group of high level performers. We know what some swimmers deal with pain better than others, but this remains a difficult quality to measure within swimmers of similar fitness.
However, the ability of acute exercise to improve how subjects deal with swimmers pain is well established, (Naugle 2014) though “pain” in the context of that literature is not a perfect analog to the pain of high level swimming (does pricking a pin in the lab equate to the pain of a 200fly race?). Yet one lesson from that line of research that may transfer to competitive sport is that vigorous exercise tends to increase pain threshold, suggesting that exposure to high intensity training is key for race readiness (no big surprise there!).
The still unanswered question is whether these qualities are trainable. As we wrote in “Is Mental Toughness Trainable” “[I]t’s important to distinguish between the mental stressors inherent in high level sport with stressors added for the sole purpose of developing mental toughness. The inherent stressors are unavoidable, but it is imperative that we continue seeking a justifiable definition of “toughness” rather than assuming that those who survive toughness training have actually benefited from the experience.”
Interestingly, one measure which may have potential for improving how swimmers deal with pain is sleep, a popular topic on this site. Though not testing swimmers, Brand (2014) found that, “Greater mental toughness was related to more favorable quality of life and increased subjective sleep. Mental toughness was not related to physical activity. Increased mental toughness, favorable quality of life, and sleep are related during early and mid-adolescence. Against our expectations, mental toughness was not related to physical activity.”
Like many areas, there remain more questions than answers. We know that different swimmers cope with pain differently but quantification is difficult. That said, it does seem that training may have some effect on pain perception though the exact parameters are still unclear until research in conducted on swimming populations.
One idea which has been tested in running (unpublished, to my knowledge) is to assess how stroke parameters change among swimmers at identical exertion levels with identical fitness levels. There are many technical variables to account for in this type of study, but it would be one direction to take the research for answering these questions in the pool.
- Brand S1, Kalak N2, Gerber M3, Clough PJ4, Lemola S3, Pühse U3, Holsboer-Trachsler E2. During early and mid-adolescence, greater mental toughness is related to increased sleep quality and quality of life. J Health Psychol. 2014 Jul 24. pii: 1359105314542816. [Epub ahead of print]
- Jones MD1, Booth J, Taylor JL, Barry BK. Aerobic training increases pain tolerance in healthy individuals. Med Sci Sports Exerc. 2014 Aug;46(8):1640-7. doi: 10.1249/MSS.0000000000000273.
- Naugle KM1, Naugle KE, Fillingim RB, Samuels B, Riley JL 3rd. Intensity thresholds for aerobic exercise-induced hypoalgesia. Med Sci Sports Exerc. 2014 Apr;46(4):817-25. doi: 10.1249/MSS.0000000000000143.