Pain Tolerance: How Could Kilian Jornet Run 86 Miles with a Dislocated Shoulder and Win the Hardrock 100 Ultra?

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What is pain and how does it relate to enudrance sport. Pain Tolerance: How Could Kilian Jornet Run 86 Miles with a Dislocated Shoulder and Win the Hardrock 100 Ultra?

While taking part in the 2017 Hardrock 100 ultra-marathon, Kilian Jornet fell and dislocated his left shoulder around 16 miles in. Without painkillers and with the affected arm immobilized, he ran the remaining 84 miles and won the race. How did he do it? Is he super-human (probably!), or does he have a higher pain tolerance than the average mere mortal?

In an interview, Jornet remarked that the fall and dislocation of the shoulder was very painful, but after he pushed the shoulder back in place it hurt less. He then tried to keep the affected arm still by using his hydration vest as a sling. The jarring movements of down-hill running however made the pain worse, so medics at an aid station completely immobilized the arm with bandages. According to Jornet, he initially didn’t think he would be able to finish the race due to the level of pain he experienced. I had pain when I fell, but afterward, I found a way to stop the pain, so then it was good,” Jornet told the interviewer.

How did he manage to continue such a grueling race, to finish and to WIN while smiling the entire way?

Klian Jornet Runner
Kilian Jornet. “Ultra Cavalls Del Vent 2012” by Gerard Reyes. Lincenced Under CC By-SA 2.0

Scientists have done a lot of research on pain threshold and pain tolerance. Although we can only speculate about the specific strategies Jornet employs to push through pain, the science behind pain management is fascinating. We took a closer look at what exactly pain is, and how it relates to endurance sport.

What is pain?

So what exactly is pain and how do we perceive it? Dr. Doris Cope MD says that “Pain is both a biochemical and neurological transmission of an unpleasant sensation and an emotional experience.”  We thus note that there are two aspects to feeling pain. The first involves the infliction of damage or potential damage (stubbing a toe) resulting in a message that is sent to the brain. The second step is how the brain perceives the message of pain and what happens next. Is the pain message dismissed or does the person drop everything and focus on the pain?

At this point we also have to differentiate between pain threshold and pain tolerance. According to Wikipedia, pain tolerance is the maximum level of pain the a person can tolerate. An individual’s pain threshold is something entirely different. The threshold of pain is where an individual starts to feel the stimulus of pain. Both pain tolerance and pain threshold vary greatly from one person to person the next. One person may have a very low pain threshold, i.e. feel pain quicker than another, but tolerate a much greater level of pain and vice versa.

Pain Tolerance in Elite Athletes

Research shows that endurance athletes never quite reach their full physical potential in a race. At the end of a race, there is always some spare capacity left. This is well illustrated when runners finish in a strong sprint at the end of a grueling race.  How is this explained? This is because athletes reach their full capacity of pain tolerance (or suffering tolerance) long before they reach their actual maximum physical capacity.

In his autobiography “Run or Die” Kilian Jornet describes discovering how his mind and his own perception of suffering was limiting his endurance performance. In his 2009, Jornet attempted to break the record of the 165 mile Lake Tahoe rim circumnavigation. With only 17 miles to go to the finish  he found himself on the brink of quitting. After running for more than 30 hours, he was exhausted and in a world of pain, unable to continue. At that point, none of his favorite foods or a pep talk from his myriad of pacers could lift his spirit. He describes how he then retreated into his own mind while listening to one of his go-to inspirational songs while visualizing his goal. After that, feeling “fresh and light”, he bolted off and was able to complete the effort with the same strength and motivation he started with.     

Since pain tolerance limits athletic performance, an athlete with a higher pain tolerance should outlast another in a duel of two athletes with exactly equal physical ability. This was corroborated by a scientific experiment where a group cyclists were given acetaminophen (painkillers) versus a placebo for the control group. The painkiller group was able to perform the cycling sprints at a significantly greater mean power output than the control group. It was deduced to indicate that the painkillers may have improved performance due to improved pain tolerance.

Train to Handle the Pain

Is it then possible that elite athletes may experience pain in the same way as weekend warriors? And if yes, do they perhaps tolerate pain longer and better? The answer is “yes” and “yes”. To illustrate this, a study was done where three groups of swimmers were all tested in the same way for their pain tolerance level. The three groups were all at various levels of training: elite swimmers, club-level swimmers and non-competitive swimmers. They were asked to repeatedly make fists while wearing a highly pressurized blood pressure cuff around their upper arms. The longer the experiment continued, the more severe the pain got making fists. Although all three groups had similar pain thresholds, the elite swimmers outlasted both the other groups in tolerating the pain. Also, it was found that the pain tolerances of the elite swimmers improved even more as the competitive season progressed, and was significantly reduced after a season of rest.

So why is it that elite athletes can handle pain so much better? The short answer is that they train for it. Training doesn’t only serve to improve fitness, but it also familiarizes athletes with the pain associated with the sport and how to cope with it. With increased exposure to the pain, so pain tolerance is increased.

In a Nutshell

When Kilian Jornet dislocated his shoulder during the 2017 Hardrock 100 it was the fourth time this happened to him. He figured “It’s an arm, not a leg like you need for running, so it was not a big deal”. For somebody else it might have been a very big deal. Have you tried running a short distance with one arm immobilized? Now imagine going for gold in an ultra with only one movable arm.  The compensation of other body parts to pick up the imbalance will cause severe discomfort, if not pain, allover.

Jornet is, however, not new to the pain game. He has quite a number of extreme endurance events (with wins and records) under his belt. He is familiar with the territory. He knows how to deal with pain. Yes, he feels it just like most other mere mortals. But through familiarization, sufficient exposure and practice he has found mental ways to cope and to push through pain barriers to tap into his real physical abilities.