To Pain or Not to Pain

To Pain or Not to Pain

To Pain or Not to Pain


“No pain, no gain” is a phrase every runner has at least heard at one time or another. Probably most at some time or another have succumbed to this philosophy, if not outright embraced it. While almost all runners “know” that certain types of pain are undesirable and indicative of injury and should be avoided, just as many are likely to believe that “unpleasantries” such as overused or fatigued muscles may be referred to as “positive pain.” “Positive” in this context indicates improvement — in terms of performance, health, psychological outlook, etc. But is this really the case? Is there such a thing as “positive pain” with running?

I recently came across an interesting study conducted a few years ago by a psychologist at Regis College in Denver (Journal of Sports Medicine and Physical Fitness, Sept. 1991). The purpose of the study was to assess what percentage of runners push themselves until they feel pain and then to compare the “pain runners” to “non-pain runners” with respect to the following: demographics; motives; risk-taking characteristics; medical symptoms and injuries; performance and; death thoughts and death anxiety. A total of 800 runners in New Mexico and Texas were asked to fill out questionnaires, with 370 responding, 78% males and 22% females. The results may surprise you:

Based on the answer to the question “Do you push yourself during running until you feel pain?” using a four-point scale, subjects were classified as either non-pain (choices never or rarely) or pain (sometimes or often) runners. Fifty-six percent of the respondents fell into the pain group, 44% in the non-pain category. Of males, 60% were pain runners, while females registered only 43% in this group. Demographically, when both sexes were statistically combined, pain runners were generally taller by an average of two inches than their non-pain counterparts (must have to do with the thinner air!), weighed an average of 8.3 pounds more (which could be the result of being two inches taller) and were 2.1 years younger.

Some of the results should not really be much of a surprise. Pain runners are more likely to be “risk-takers” — e.g., running in 100+ or below zero weather, ice, snow, high traffic areas; continue to run at the same pace or increase speed when first feeling pain; run with an illness. They are more likely to suffer musculoskeletal injury or other medical symptoms such as headaches, nausea, dizziness and chest pains. And, with regard to motivation, they are more likely to run for competition and less likely to run for improved health.

There are two areas analyzed which do offer some surprises. First, it appears pain runners are more likely to experience death thoughts and death anxiety than non-pain runners. (The paper does not specify whether these thoughts and fears occur during running or in general at other times.) Given the widely-held belief that the release of certain brain-chemicals (endorphins) into the bloodstream during running causes a feeling of euphoria or well-being, one would expect the opposite result.

Second, given the fact that pain runners see themselves as more competitive, we would expect they would perform at a higher level. But, in fact, there were no significant differences between the two groups on years running, average mileage per run and week, average time per mile, or number an personal record for marathons or half-marathons. In other words, it appears that pushing to pain does not improve performance.

If the results of this study are valid, the concept of “No pain, no gain” certainly seems to need some serious re-evaluation. And likewise, the term “positive pain” may be just another oxymoron.

P.S. To those who know me … “Do as I say, not as I do.”

Gabe Yankowitz

Gabe is a long-time runner and physical therapist currently practicing in Manlius. Gabe is a physical therapist in Central New York for the past 35 years, specializing in orthopedic treatment and rehabilitation. His website is

  • Physical therapy degree from Upstate Medical Center (1983)
  • Doctor of Physical Therapy degree from the Massachusetts General Hospital Institute of Health Professions  (2007)
  • Board-Certification as Clinical Specialist in Orthopedic Physical Therapy (2009).