“Wow! Amazing!!” I said one day. This was on the day I discovered an article entitled entitled “A naturalistic investigation of former Olympic cyclists’ cognitive strategies for coping with exertional pain during performance”. It was by Jeffery Kress & Traci Statler detailing a fascinating study of nine former Olympic cyclists and was published in 2007 by the Journal of Sports Behavior (1).
What was ‘pain’ for the cyclists? How did they deal with this pain?
This review blog consists of 4 posts. This 1st post will discuss methods and the cyclists’ personal description of pain. The 2nd post will focus on their perceptual and temporal modification of pain. Then the blog’s 3rd and 4th posts will discuss preparing for and ways of handling pain.
To digress, as a long-distance runner/scientist, learning how to utilize cognitive strategies has been critical. For me, the study’s focal point was really attention-grabbing!
I admire how Kress & Statler ‘tackled’ operationally defining the vital phenomenon of exertion pain. It was defined to the participants as “the pain you feel when you are riding very hard, not the pain you feel when you have sustained an injury.” Please note that they carefully described “exertion pain” near the beginning of an interview even before the first guiding question. Thus they separated this component of pain from injury-related pain. And in the article’s introduction section, a more precise definition was given as “the intense discomfort felt when performing at sub-maximal or maximal levels.” Very, very interesting; please notice that the term “discomfort” was substituted for pain.
Methods. But even more intriguing was the methodology used by Kress & Statler. They began by constructing a series of ”basic questions” to ask all participants. First, “… describe what that exertion pain felt like and how they each dealt with it.” Second, “Describe your perception of exertion pain when you were racing or training.” And third, “Tell me about pain in bicycle racing and what you did to cope with it.”
Then, the principle investigator interviewed and tape recorded the first subject, adding other probing questions during the last part of the session. After each interview, the investigator transcribed its tape, adding new “salient [emergent] issues” that were identified for possible probing during the next interviews. Next, another subject was interviewed with this process repeated. In each of the transcripts, individual “standalone” quotes were identified and added to a similar category of quotes or was used to create a new category. A total of 222 quotes were processed into 16 categories that formed the lower-level themes. Of these, 12 were then integrated into 3 separate higher-order themes. The remaining 3 lower-level themes were promoted to be higher-level themes. With this methodology, Kress & Statler identified the following 6 higher order themes: Pain, Preparation, Mental Skills, Mind/Body, Optimism, and Control.
As the quotes were analyzed,, they did discover a higher-level theme they named Pain. This pain theme emerged when they considered three similar yet different lower-level themes: description of pain, perception of pain, and time to termination.
RESULTS (Summarized on Part 1)
Description of pain. The former Olympic cyclists were well aware of exertion pain. “In this quote from Ivan,” the investigators commented that, “exertion pain was described as being something quite out of the ordinary and unpleasant.” Then they quoted Ivan to say:
“Obviously, there is a big difference between exertion pain and any other physical kind of pain. The exertion pain I would term as a kind of fire … a burn pain. I have never had a severe [burn] from a fire but if it were to be like that, it would be throughout your whole body. Every square inch of it. If you are really exerted and you are going flat out, I can’t think of much worse. It’s like a burn or an electric shock type thing. It’s there and it really hurts. Your lungs are gasping for air while your legs are on fire … or worse.”
Further on when describing the Mind/Body higher-order theme, Kress & Statler quoted Frank as saying: “Legs are burning. Lungs are searing. …. muscles are dying. … The body is trying to pull the mind away from what it should be concentrating on. That’s really a big struggle.”
And below that in an “Optimism” lower-order theme, “Accepting Pain as Part of the Sport,” a cyclist, Bill, noted this about pain: “…it’s indescribable and your just learn to deal with it.”
Comments
In summary, Kress & Statler found that former Olympic cyclists “know that endurance pain exists” and that “exertion pain was out of the ordinary and unpleasant.” When the cyclists “were riding very hard,” several used these descriptions for pain: “Burn Pain,” “Legs on Fire,” ”Electric Shock,” and “Muscles are Dying”. Those words have a familiar ‘ring’ for me.
Not only did the cyclists validate the investigators’ definition of exertion pain, they also verify words that many of us use for our own verbal descriptors of pain. Many scientists prefer only to discuss symptoms by referring to the mechanisms that may provoke them and avoid the fact that athletes ‘live’ by their feelings. “Describing how emotion experiences are caused does not substitute for a description of what is felt,” wrote Barrett et al. (2), “and in fact, an adequate description of what people feel is required so that scientists know what to explain in the first place” (for a review, see 3). Kress & Statler have boldly honored the cyclists by asking for descriptions of their endurance pain.
In this post, the first of four for this blog review of Kress & Statler’s 2007 article, I examined their ‘down-to-earth’ methodology and summarized quotes for the theme: “Description of pain.” This theme was the first lower-level theme of the Pain higher-level theme.
What causes Pain? In the discussion of Pain, the investigators noticed the riders believed one of two causes for the pain: It was “others” that cause the rider to be in pain, or it is the rider who create their own personal pain? Note this other quote they used from Frank: “The experience of pain is voluntary. What we do is not an involuntary thing … You do this by choice.” Then Kress & Statler concluded “that if one accepts the pain, then one can employ effective coping strategies.” Therefore, the awareness of pain allows us to cope with pain.
Guess what? How the cyclists notice exertion pain is the topic of the next post. I discuss the sections in their results about the themes “perception of pain“ and “time to termination.” The cyclists’ quotes are noted, and the authors’ comments are summarized about these other lower-level themes for Pain.
To read more about symptoms in the Dealing with Discomfort section, (Read about Signs and Symptoms)
Also in that section you can read about descriptors of pain during long-distance running, (Read about Experiencing a Marathon)
Some of you may have some unanswered questions about noticing exertion pain. Well, I do! So far in beginning to understand Kress & Statler’s intriguing article, my list of unanswered questions are these:
- Do the symptoms cyclists report come from their private speech, that is their self-talk? And if so, how come we talk to ourselves in the first place?
- What have other studies revealed about the type of pain symptoms we experience during cycling? (Let’s remember that cognitive strategies was the focus of their study, rather than the symptoms per se.)
- Is there an effect of intensity on the symptom types reported?
- Is the processing of symptoms uni-dimensional or multi-dimensional? Does the dimensional organization of symptoms provide hints about mechanisms that provide feelings and cope with them?
- And do all persons use the same amount of detail when reporting symptoms? If different, what influence does this have on creating miscommunication during training?
For the curious, this review is continued in the Reviews section on this site. (Go to Review for Curious about Exertion Pain)
References
1.Kress, J. L. & Statler, T. (2007) A naturalistic investigation of former Olympic cyclists’ cognitive strategies for coping with exertional pain during performance. Journal of Sport Behavior, 30,428-452.
2. Barrett, L. F. (2004) Feelings or words? Understanding the content in self-report ratings of experienced emotions. Journal of Personality and Social Psychology, 87, 266-281.
3. Barrett, L. F., Mesquita, B., Ochsner, K. N., & Gross, J. J. (2007) The experience of emotion. Annual Review of Psychology, 58, 373-403.
Last revised: January 27, 2011
