In a special effort to acknowledge the grueling nature of the Tour de France – this qualitative research on the experience of “suffering” in cycling will open your eyes.
Editor’s note: The vast majority of literature in sport psychology involves quantitative research methods. These help in understanding trends and the prevalence of applied methods or conditioning skills, however, they are sometimes written in a way that feels remarkably alien to our actual experience of the techniques as applied. For an “up-close and personal” understanding of applied methods, there is no better tool than that used in qualitative research. This article, by UK Psychologist Phil Moore, puts forward this methodology so that we not only grasp the experience of “suffering” involved in cycling, we get a better sense of how individuals gravitate toward certain coping strategies. As focused as this study was on cycling, many of us will realize benefits in other endurance sports. Podium Sports Journal is pleased to present this research, not just because it is inherently relevant to our mission, but because Mr. Moore does an excellent job illustrating the difference between research and loose journalism which often plays fast and loose with concepts that are barely defined, much less understood.
by Phillip S. Moore – University of Exeter – England
Performance and Pain
Any cyclist will know that whilst cycling can be very enjoyable, at the same time it can also be very painful. On an extreme level let’s imagine for a moment the pain caused from a hip injury severe enough to require an immediate hip replacement. Let us then imagine how this must feel coupled with riding up to 260k a day, for three weeks over terrain up to 2600 metres. Finally, let’s imagine how painful it must be to not only cope with this pain and complete this epic task, but to beat a field of over 200 elite competitors. Floyd Landis’ achievement in this year’s Tour de France is inspiration for any keen cyclist, but it poses several important questions regarding the psychological experience of pain and its relationship to performance. How do elite cyclists like Floyd Landis experience pain and how do they best cope with it?
Social Science in Sport
Traditionally, attempts at improving athletes’ performance based on physiological factors such as training methods, diet and recovery have received the most attention from coaches. However, the burgeoning of sport psychology as a discipline, and even more recently as a profession, reflects the increasing credence modern athletes and coaches give to psychological influences upon improved performance. The experience of pain as a research topic has received marginal attention within the literature to date (see Hogg and Hayden (1997) for an exploration of runners’ experiences of pain). One reason for this is that the youthful status of sport psychology as a discipline, tends to shun the often overlooked or disregarded value of qualitative research methods. Pain is undoubtedly a qualitative experience, and one that cannot be easily quantified nor reduced to digits. It is unfortunate (yet predictable) that the discipline of sport psychology has fallen into the misguided pursuit of truth rather than value; however, this short paper offers some value in exploring the subjective experience of pain for elite cyclists. It is a brief synopsis of the findings of an original qualitative research project entitled: Perceptions of pain in competitive cyclists (Moore & Rock, 2001). The research involved interviews with four elite British cyclists, using semi-structured questions to elicit information. The information was interpreted using a phenomenological approach, respecting the individuality of what people said. Any psychological model was applied after the information was gathered, and so the design was emergent in essence.
Firstly it is important to distinguish between injury pain and exertion pain. Exertion pain is typically perceived as acute, short in duration, produced voluntarily, under the control of the athlete, and capable of being reduced at will. Exertion pain can consequently provoke positive emotions, feelings of satisfaction, improved performance, high self-efficacy, and a heightened sense of well-being. It can, therefore, facilitate athletes’ efforts by reinforcing them to aspire to higher intensities in training or competition.
Although rare individuals like Landis (and his collapsing hip) seem to dispel what we know about injury pain; it is commonly experienced as chronic, long lasting, uncontrollable, a risk to physical well-being and motivation for athletes to protect the injured area. Typically, an athlete will respond with a loss in self-confidence and motivation, increased anxiety and/or depression, and feelings of fear. Injury pain is thus seen as a negative and discouraging (Heil, 1993). Taylor (1997) has developed these distinctions further, in suggesting that each type of pain, has significant effects upon how an athlete perceives pain (positively or negatively), evaluates pain (benign or harmful) and responds to pain (continued effort or protection). Hogg and Hayden (1997) indicated that when competitive runners correctly identify exertion pain, it has many positive emotional outcomes, including motivation, happiness, and satisfaction.
So our experience of pain is not sensation per se, but a product of how we perceive it. Tajet-Foxell and Rose (1995) have suggested that repeated exposure to painful stimuli may reduce pain response in some individuals (process of habituation). In their study of ballet dancers they discussed how high pain thresholds were not only a result of habituation to high physical training and fitness levels, but were also contingent upon changes in cognitive responses over time. It seems that seasoned athletes use different ways of thinking and processing pain information. Researchers such as Morgan (1985) have highlighted the principles of adaptation in pain tolerance and perception, whilst others have agreed that an athlete’s unique training regime may affect an athlete’s ability to cope with pain (Egan, 1987).
Reward and Punishment: Pain and its Meaning
To make sense of the world around them humans tend to construct themes, make links and group information together. Our experience of pain is not immune to this; and this is how we learn to avoid or to repeat behaviour. In basic behavioural terms, if something we do benefits us we are likely to do it again. In more detailed terms: an athlete’s emotional response to pain is largely a product of experience, context, environment and individual difference. According to Hogg and Hayden (1997) an individual’s exposure to pain will imbue meaning for the individual. An athlete’s drive and the tendency to persist with certain behaviours, is in part, determined by an expectation of an outcome. For example, if Landis’ efforts at the Tour de France result in success, he is more likely to interpret the pain as a means to a successful end, and is likely to repeat his efforts. An athlete, whose experiences of pain are coupled with defeat or relative failure may be at risk of associating emotions of fear. According to Heil (1993) an athlete’s ability to tolerate pain depends on the likelihood of positive outcomes, such as good performances or results. Furthermore, Heil (1993) describes strong goals; a predominant perceptual focus on sport related cues (over pain), and a survival context as important factors in an athlete’s ability to tolerate pain.
Athletes use a variety of these coping techniques and cognitive strategies, and several sport specific studies have discussed them (Hogg & Hayden, 1997; Taylor & Taylor, 1998). Pain reduction techniques include deep breathing exercises, muscle relaxation, meditation, and therapeutic massage. Pain focus techniques on the other hand are concerned with external focus techniques, soothing imagery exercises, neutral imaginings, rhythmic cognitive activity, pain acknowledgement, dramatic coping, and situational assessment (see Heil (1993), Miller & Maas-Hill (1999), Vealey & Walter (1993) and Walker (1971) for a discussion of these styles and techniques).
Summary of Findings
What follows are extracts from the interview transcripts of four elite British cyclists, and comments from the researchers’ interpretation of the data. Participant quotes are indented and are coded with a letter to denote which participant made which comment.
Physical Descriptions of Exertion and Injury-related Pain
The most common physical pains experienced by the cyclists interviewed, were pain in the legs and lungs. Injury pain was described very differently from exertion pain. Injury pain was often likened to somebody sticking a needle or cigarette into the body.
â€œWhen you are really exerting yourself it is like an ache, a burning sensation, but if you get pain from an injury in your knee or ankle, itâ€™s more of a real sharp pain… like someone’s sticking a needle inside. – (C)
Negative Emotional Effects of Injury-related Pain
Not only were the descriptions of injury-related pain different from exertion pain, but so too were the emotions associated with injury pain. Emotional responses to injury-related pain included increased anxiety, depression, fear and feelings of having been cheated, resulting in loss of confidence and motivation.
“Injury pain is depressive, bringing me back down to Earth, making me feel more mortal, as I don’t feel mortal when I am doing well, you feel robbed, cheated.”(D)
Feelings of helplessness and defeat linked with injury pain were associated with lack of control over the pain, which contrasted with the voluntary nature of exertion pain, and the fact that it could be reduced at will. The controllability of exertion pain was an important factor affecting the experience of its intensity.
Positive Responses to Exertion Pain
The predominant emotions associated with exertion pain were very different. Exertion pain was described in more positive ways than injury-related pain. Participants described exertion pain as a common source of satisfaction and inspiration, creating positive thoughts and emotions that facilitated performance and well being.
“Well you don’t enjoy the pain, you enjoy the feeling of going flat out and not caring. And you almost want it to hurt more when you go faster, just because you feel so ace (good).” – (A)
The sensation of exertion pain was never described as pleasant, in fact the sensation was unpleasant and stressful. The effects of exertion pain, on the other hand, were regularly perceived in positive ways. Exertion pain created positive meanings for the participants who related exertion pain with increased fitness, form, and success.
“My thoughts about pushing myself are pleasurable ones, knowing that I have done something that’s going to be good later on.” – (B)
The controllable nature of exertion pain presented an opportunity for participants to mediate other cyclistsâ€™ experiences of pain, particularly in competitive situations.
“When you are in a break away and you are feeling really strong, then you are making other people suffer.” – (B)
Not only does the knowledge of others’ pain facilitate the participants’ ability to control their own pain, but in some ways, it can actually alter the perception of pain experienced. Feelings of high motivation, euphoria and superiority were often reported at times of intense exertion and competition. The pleasurable effects of pain may become desirable rewards that may have a reinforcing effect upon training and competition.
“I enjoy seeing other people suffer, that’s why I do it, to get that superiority over others. I don’t know why I like that, it’s pathetic really. But being better and more superior gives me that drive. Sticking with riders until they break down is like driving it in a bit. To see them suffer a bit more, the more I will hammer it.” – (D)
Pain to some of the participants took on tangible qualities, and became an entity that could be used as a weapon on others. Participants not only acknowledged the ways in which others’ experiences of pain could be manipulated through tactical riding, but they also actually envisioned the physical infliction of pain onto others.
“…on top you know you can dish more (pain) out if you want to.” – (A)
Participant “D” used other cyclists’ signs of pain to inform his own tactics and to positively re-frame his own perception of pain.
“The earlier I see others struggle, earlier than I do, allows me to shut out the pain…..and when they show it (their experience of pain), I think that”s it! He has broken. I can then make my attack and go.” – (D)
When exertion pain was encountered, participants used coping strategies, which they felt were most effective. The coping strategies they used were predominantly self-discovered, and thus, were on the whole, not the product of any formal mental skills training. The four participants each used various techniques that can be grouped into three types: rhythmic behaviour, distraction, and establishing an end.
Only participant “A” had formal mental skills training following consultation with a sports psychologist. He believed the strategies were effective, and that formal skills training was vitally important for elite development in cycling. “A” used “power” words, and imagery to focus his concentration, distracting himself from the pain.
“I focus and block it out, I say power words. Words that take your mind of it and that you can associate with the things that make you ride better….Like strength, smooth, speed, you’re thinkin’ to yourself you’re a good climber, you’re visualizing how you should be doing, how you would like to be doing it.” – (A)
“A” used imagery by visualizing he was a tiger to provoke arousal, and to provide a distraction from the pain.
“When you’re battering everyone, it’s easier to believe you’re a tiger.” (A)
“B” on the other hand, perceived pain in predominantly physical terms, and so used mainly physical aids to relaxation and performance. “B” did not value the mental importance of success in cycling so highly as “A”. He was asked if he had ever sought mental skills training. He said “no”, and instead emphasized the use of physical techniques that he had learned from reading books.
“Well, stretching to start with. From a training point of view… after training to warm-down, sort of thing. And then go into stretching.” – (B)
He had not sought formal mental skills training, mainly because, he felt that coping with pain was an ontogenetic process that evolved from individual trial and error. When asked if he thought mental strategies were useful, he replied:
“No, not really. It’s time if anything. Remember you have to do the training. And people have their own methods, watching T.V. or reading a book.” – (B)
However, during a follow-up telephone interview “B” stated that he was not sure if his coping strategies had developed from cycling in particular, or as part of general life experiences. Participant “B” did stress a personalized quality to the pain coping process, and he was certain that individuals have their own techniques to cope with the pain. He used sub-vocalization to distract himself from the stress of exertion pain.
“I sing actually. To take my mind of it.” – (B)
“C” also perceived his coping strategies as an outcome of his individual experiences within cycling and with pain and he suggested that techniques that he had learned through studying sport psychology were already a part of his daily cycling rituals.
“…there was a lot that I learned that I was actually doing…When I did this course it told me what I was already doing, but guided me a bit more.” – (C)
“C” regularly found it useful to focus on the end of a task, or would alternatively sub-divide the task, and therefore create more ends.”
“If it happens on a hill I have a look and think, it’s only another ten or fifteen seconds to the top. That’s nothing.” – (C)
“C” would come to terms with the reality of the pain to be experienced, and interpret his estimate of pain as a challenge to overcome, and find achievement from closure of each task.
“It ain’t gonna last for ever, that’s what you have to get into your head, I will be home soon.” – (C)
“C” used aggression to cope with exertion pain on occasions. Increasing arousal through psyching up, and becoming aggressive enabled him to distract himself from exertion pain. By perceiving the aversive properties of exertion pain as the enemy, he managed to channel his energies into performance.
“People came to me at the end of the race and said: how did you do that last lap so quick? I don’t know I just got fired up because of the delay at the crossing. All that aggression… a bit of the aggression came out on the stewards, but the rest came out on the bike.” – (C)
In direct contrast to “B”, “C” would use music not to lower his arousal, but rather to increase it.
“I like training with a walk-man on, I try and get them going round to the beat. If you have the music on it can make you feel: I wanna do this. It psyches you up and gets you going. Its like going to a disco or night club, if some real good music comes on you go and have a dance to it, that buzz you get from the music can help your training.” – (C)
“C” likened the phenomenon to a separation of mind from body. To him, coping techniques seemed to be second nature. He suggested that different situations required different coping strategies. For example, in circumstances where exertion was high, he would use less demanding cognitive rituals such as counting. In longer, less intense situations he would have the resource to use higher cognitive activities, such as rehearsing favorite songs.
“I will probably use the counting one more than anything, for intense oxygen debt pain, for long endurance pain it’s slightly different, you think of things like music. When you think of the tunes you can shut everything out, pounding the gears in beat with what you are doing in your mind, I try and dispatch my mind from my body… usually I don’t notice doing them.” – (C)
Similarly to “C”, participant “D” used counting as a technique. “D” would co-ordinate his breathing with his pedal strokes, and count each stroke.
“Count the breaths, ’cause for one it keeps your concentration up, and then you can co-ordinate the breathing with your pedal strokes. I will get 3 quarters up the hill and won’t have thought about the pain, because of the counting.” – (D)
Like “A”, “D” rated mental aspects of performance very highly, yet he avoided formal mental skills training. “D” valued his skills of coping with pain as a product of general life experience, such as those gained from spending time in the army.
“…it all came about when I joined the army, suddenly I was mixing with men. Blokes (men) that were smoking and drinking, with big beer bellies, I was 18 or 19 and in my prime of fitness supposedly, but I couldn’t keep with them, nowhere near them in fact.” – (D)
Similarly, “A” also rated the importance of discipline in increasing pain tolerance.
“I think that it’s about attitude – The more professional you are about things, I think the more tolerant you are to pain. At the end of the day it comes down to who wants it most.” – (A)
Interestingly, D’s interpretation of pain included abstinence from indulgent activities, such as socializing with friends, eating fatty foods, drinking alcohol, and spending time with his partner. He valued the experience of exertion pain, and all his other “pains” in life, because for him these “pains” helped him increase his tolerance to pain, and fine tune the ways in which he coped with pain.
“…if you suffer enough you suffer the most, then you will win. That doesn’t only mean the pain in sport, it means the things that you give up in life generally. You have to make sacrifices to be that successful, whether it’s not going out to parties, not drinking, not eating certain foods…… Suffering is definitely there, but it may not always be physical soreness, and pain, it can also be heartache… But I think if you can handle it, push it and give it out and take the most pain then racing is easy. And the more you can suffer in training, sometimes you will experience more pain than competition, and if you can do that, it makes competition even easier.” – (D)
In line with the research of others such as Heil (1993), it appears that even though pain is intrinsically an aversive sensation, it can be perceived positively. Participants described exertion pain as a common source of satisfaction and inspiration, creating positive thoughts and emotions that indicated effort and facilitated performance and well being. It is not surprising why athletes repeat pain evoking activity if it becomes essentially a positive experience. Perhaps those like Landis and other successful elite athletes are quick to perceive pain positively? Research and further understanding towards successful injured athletes is warranted.
Pain as a Psychological Weapon
Participants in this study suggest that the positive outcomes of exertion pain can create feelings of power, where pain can be used as a “psychological weapon” for use on competitors. Mood elevation; increased confidence; feelings of superiority; and feelings of control over others’ experiences of pain and effort, are all possible outcomes of exertion pain. Such findings extend Heil’s (1993) theory of the “social sphere” of pain, whereby athlete’s responses to pain can sometimes be mediated by the ways in which others display pain. Heil (1993) suggests that whether overtly or reluctantly displayed, others’ reports and limits of pain, not only serve as an informational means of gaging one’s tactics, but also play a key role in determining one’s own perception of pain. Participant reports from the present study additionally suggest that those “on the receiving end” may experience a heightened sensitivity to the negative aspects of pain, when interacting with others who appear “on top”.
Which Coping Style?
The present study revealed that coping strategies used to control pain, differed from participant to participant, and sometimes from situation to situation. The categories of coping strategies that emerged were similar to those identified by Hogg and Hayden (1997) and were labeled: rhythmic cognitive behavior, distraction or dissociation, and establishing an end. Participants believed that their own coping strategies were spontaneous, instinctive and largely unconscious. Participants also believed that such coping strategies effectively influenced their experience of pain, and that they were both situation and person specific. Heil (1993) proposed that counting, repeating a mantra, or singing to oneself, works to draw attention away from pain, by focusing attention on rhythmic activity. Such rhythmic activity may have a calming and stress reducing effect similar to that which is reportedly gained through the use of meditation or hypnosis (Barrett, 2001).
Room for the Psychological
The present study revealed that participants saw the mental aspects of performance as being very important, yet most did not feel formal mental skills training to be appropriate. This supports Hogg and Hayden’s (1997) suggestion that it is surprising that so few athletes seek professional help with mental skills training, given that they generally rate the mental element of performance as being so important. Participants tended to justify the decision to focus on physical aspects of training in terms of the belief that an individual’s ability to cope with pain is intrinsic to normal development.
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About the author:
Phil Moore is a Trainee Clinical Psychologist at the University of Exeter, England. He has studied and worked in psychology for ten years, working in the fields of learning disabilities, child psychology and adult mental health. He is a keen cyclist and has a special interest in exercise and psychological health.