In-Race Pain Management: Pain Tolerance vs. Pain Distraction—How to Choose Between the Two Strategies?

1. Two Sources of Exercise-Related Pain

First, it’s important to distinguish between harmful pain and normal pain:

Harmful Pain (Must Stop)

• Sudden, sharp, well-localized
• Joint clicking, stabbing pain
• Muscle tearing sensation
• Action principle: Stop immediately

Training Pain (Can Be Managed)

• Gradual, diffuse, bilateral and symmetrical
• Muscle burning, heaviness, soreness
• Relieved by adjusting pace
• Action principle: Management strategies are optional

This article discusses the latter.

2. The Neural Mechanisms of Pain

Exercise-related pain is generated by three systems working together:

System	Signal	Effect
Peripheral receptors	Lactic acid, H+, inflammatory substances	Muscle soreness
Spinal gating	Suppresses or amplifies signals	Overall pain intensity
Brain interpretation	Assigns meaning	“Pain = danger” or “Pain = training”

Key point: The brain’s interpretation accounts for 60-70%! Given the same physiological stimulus, elite athletes perceive 30-40% less pain than amateurs.

3. The Two Main Strategies

Strategy A: Pain Tolerance (Associative)

Approach: Face the pain directly, coexist with it, and don’t try to escape it.

• Observe the sensation: “What is this pain like? Ache? Burning? Heaviness?”
• Label without judging: “My legs hurt” rather than “I’m about to fall apart”
• Accept: “This is the price of training; it will pass”

Advantages:

• Maintains body awareness (prevents injury)
• Precise pacing, technique doesn’t break down
• Builds long-term mental resilience

Best for: Elite athletes, technique-based events, those needing continuous pace monitoring

Strategy B: Pain Distraction (Dissociative)

Approach: Shift attention outward, avoiding focus on the pain.

• Observe the environment: roadside scenery, other competitors
• Count things: steps, trees, utility poles
• Mental games: recite lyrics, do mental math
• Think of stories: family, future plans

Advantages:

• Lighter psychological load
• Subjective perception improves quickly
• Suitable for recreational runners

Disadvantages:

• May miss injury warning signs
• Pacing can easily go off track

Best for: Recreational athletes, hitting the wall, the latter half of long distances

4. Comparing the Effectiveness of the Two Strategies

2008 Lohse & Sherwood study:

Metric	Tolerance Group	Distraction Group
Subjective pain (VAS)	7.2	5.8
Pacing stability	High	Medium
Finish time	Faster (elite)	Faster (amateur)
Injury risk	Lower	Higher

Conclusion: Elite athletes perform best with Tolerance; amateur athletes perform best with Distraction.

5. Hybrid Strategy: Switching by Segment

Advanced approach: switch strategies based on race segment.

Segment	Recommended Strategy	Reason
0-10K	Tolerance	Pacing is most critical
10-25K	Mixed	Comfort zone allows relaxation
25-32K	Distraction	Mind needs relief
32-40K	Tolerance	Refocus, push to the finish
Final 2K	Tolerance	All-out effort

6. Practical Techniques

Tolerance Technique 1: Body Scan

Check each body part from feet to head for 30 seconds:

• Feet: Is the landing light?
• Calves: Any cramping?
• Thighs: Can they keep lifting?
• Hips: Any tilting?
• Torso: Any forward lean?
• Shoulders: Are they hunched?
• Face: Is it tense?

Adjust immediately if you spot a problem. This process is itself pain management.

Tolerance Technique 2: Renaming the Pain

• “Pain” → “Evidence of training”
• “Fatigue” → “The edge of your limits”
• “Want to stop” → “The body is protesting, but it won’t kill you”

Distraction Technique 1: 5-4-3-2-1 Sensory Method

Do this when you’re exhausted:

• See 5 things
• Hear 4 sounds
• Feel 3 sensations
• Smell 2 odors
• Taste 1 flavor

Takes about 60 seconds and can temporarily push the pain to the background.

Distraction Technique 2: Number Games

• Count backward from 1000 by subtracting 7
• Recite pi from memory
• Mentally calculate today’s date × your age

7. Training Pain Tolerance

Method: Interval training + deliberately extending the final set.

For example, in a 6×800m interval session, when you reach the 5th set, tell yourself “do one more set”, deliberately pushing yourself to the limit. Do this 1-2 times per week, and after 6 weeks your pain tolerance will improve significantly.

Advanced: CWI (Cold Water Immersion) Tolerance Training

• Fill a tub with 10°C cold water, start with 1 minute of immersion and increase weekly
• Use breathing techniques (4-7-8) to get through it
• Train the ability to “stay calm while uncomfortable”

8. Pitfalls to Avoid

1. Completely ignoring pain: Could lead to injury
2. Excessive heroism: “Toughing it out” could ruin an entire season
3. Using a single strategy: Only using one method without switching
4. Using it without practice: Trying a new method on race day

9. The Psychological Bottom Line: Pain ≠ Suffering

Mentor Murakami Haruki wrote in What I Talk About When I Talk About Running:

Pain is inevitable. Suffering is optional.

Pain is a signal from the body; suffering is a story told by the brain. You cannot eliminate pain, but you can choose whether to turn it into suffering.

Next time you hit the wall, ask yourself: Is this pain, or is it a story I’m telling myself?

Related Reading

• Pain Tolerance Training: Pain Management Strategies in Running
• Pain in Endurance Sports: How to Tell the Difference Between Discomfort You Should Push Through and Warning Signs You Should Stop Immediately
• Pain Management in Endurance Sports: A Psychological Perspective
• Pain Perception in Exercise: Can Pain Tolerance Be Trained? A Complete Breakdown from Science to Practice