Tuesday, May 10, 2011

Pain in the brain

Interesting article we did a few years ago on marathon running and pain - editor dave

Monterey County Herald

Conventional theory professes that it takes a lot of heart to finish a marathon. That's physiologically accurate, no doubt. But when the pain hits — as it almost always does — the more important organ might be the brain.

The human body isn't really built to run 26 miles, 385 yards, in a single day, a fact that first became evident 490 years before the birth of Christ, when a Greek runner named Phidippides was assigned to gallop from Sparta to Athens with important news. (For younger readers, this was before cell phones, if you can imagine such a world.)

The good news: Phidippides made it. The bad news: He keeled over and died after delivering his message.

"The body can only store enough glycogen (the form of glucose found in the liver and muscles) to last 20 miles," explains Mike Dove, director of training for the annual Big Sur International Marathon Clinics. "So it probably would have been nice for all of us if Phidippides had died at the 20-mile mark, instead of running all 26."

Oh, well. That, presumably, is why God created Gatorade, Goo, PowerGel and Rosie Ruiz, who, in 1980, rode a subway almost all the way to the finish line of the Boston Marathon, collapsed almost sweat-free into somebody's arms, and got her picture taken on the winners' stand with Bill Rodgers, the men's champion.

Dove, who has run 25 marathons himself, has spent part of the last six years teaching people how to complete the grueling run, including how how to deal with the inevitable discomfort that can be expected when the body rebels against the physical ordeal.

Physiologically, some people seem to be better equipped than others.

"Not everyone is born to be Lance Armstrong, or Muhammad Ali, or anybody else who seemingly has a high threshold for pain," says Dr. Chris Carver , a neurological surgeon with offices in Monterey and Salinas. "In terms of ignoring pain, some of it is a learned skill, some of it is chemical. Certain people have more potential in that area than others. It's a question that's always been a bugaboo in neurological science: How much (of pain control) is chemical, and how much is structural?"

The common denominator is that all endurance athletes rely heavily on mental skills. At some point, almost every marathon runner must deal with a level of physical discomfort that seems unbearable.

"When I work with marathoners, basically what we do is rehearse in advance and prepare for the inevitability that the pain or discomfort will come," says Curt Erickson, a Monterey Peninsula sports psychologist who also works with the U.S. Olympic Synchronized Swimming Team. "That builds confidence and helps the body relax when it hits that physiological wall."

"The wall," for a marathoner, can be very real or somewhat imagined. At its most-intense level, it can be utterly debilitating.

"If you truly hit the wall, you're pretty well gone — you're not going to finish," Dove says. "You physically run out of energy, your glycogen is completely gone, and you can't go on. Most of the time, when runners talk about 'hitting the wall,' they're not actually hitting it. But they are exhausted, they're hurting, and they're mentally down. Everybody goes through that."

That's when the mental skills take over.

"When I get to mile 21 or 22, that's when I want to start crying," says 49-year-old Maria Keilman, who ran her first marathon at last year's Big Sur International and finished in 5 hours, 5 seconds. "And that's when you really have to have a talk with yourself, mentally, stay very positive, and keep putting one foot in front of the other."

Keilman hums marches to herself ("Stars & Stripes" and "Bridge Over The River Kwai" are her favorites). She counts her strides (for her, 600 make a mile). She imagines friends and family members pulling her forward with magnets.

"Running, for me, is mental therapy," says Bill Hatch, a 46-year-old Navy Commander who not only runs marathons, but ultra-marathons (50 miles and farther). "I'll go over my day, my life, where I'm at with my family.

"I'm also constantly checking my body, trying to figure out what's going on, and why I'm feeling the way I'm feeling," he says.

All are the aforementioned tactics among three methods taught by Erickson, Dove, and others, including JoAnn Dahlkoetter, a sports psychologist who helps train Big Sur marathoners every year.

Hatch's tendency to focus on the discomfort and try to analyze it is called internalizing. Erickson says athletes often benefit by expecting the pain and regarding it as a welcome challenge when it finally arrives.

"One idea is to cooperate with the pain — 'Oh, it's you ... I've been expecting you' — and actually focus on it," Erickson says. The concept, he says, entails accepting the fact that the pain will be around for a while, then will go away. "Some people will actually give the pain a physical form — a big, black, snake, for example — and imagine themselves wrestling the snake, knowing it ultimately will not have power over them."

Thinking about friends, family or life issues, looking at the scenery, conversing with other runners, and dreaming about the finish line, are forms of externalizing, the second method.

Singing songs is one example of the third method, phasing out.

"We teach people that whenever they start feeling negative in any one of those zones, they need to immediately switch to another zone," Dove says. "If you're thinking about your body, and your thoughts are dominated by, 'Oh, God, my leg really hurts,' then you need to immediately start thinking about the meal you're going to have at the end of the race, or about catching up to the person in front of you. Try one of the other zones."

The crucial skill is to stay positive, and find ways to turn any negative into a positive. Two challenges that specifically taxes Big Sur International competitors are the strong wind — which always seems to be in the runner's face — and the seemingly endless array of hills.

Welcome the wind as an easier way to get oxygen, Dove says, or imagine that it is circling around and pushing from behind. And remember that every uphill has a downhill, and that the finish line at Big Sur is at a lower elevation than the starting line.

If the discomfort persists — and, most likely, it will — he offers these philosophies:

* It's supposed to feel this way — you're running 26 miles.

* Every other runner is suffering, too. If they can make it, you can, too.

* The more discomfort you endure, the more gratification will be waiting at the finish line.

"There is a point in every marathon where absolutely everybody, no matter how fast or how slow, says 'What the hell am I doing here,'" Dove says. "Of the 25 marathons that I've run, there were only two or three where I felt so good that I actually had energy left at the finish line. There were two or three where I was in absolute agony at the end. The other 18 ... I was just very uncomfortable for the last four or five miles. I just mentally found a way to work through it."

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