How to Power Through the Pain Cave to Find Success on the Other Side

Top ultrarunner Courtney Dauwalter is rather friendly with the “pain cave,” that uncomfortable figurative place you find when you’re doing something big (such as winning the 2019 Ultra Trail du Mont Blanc).

“The pain cave is a place we get to go when we’re really digging in to go faster or farther or asking more of ourselves than we normally do,” she says. “I believe that when we go in the cave we can work to make ourselves better, and when given the opportunity, I always go in.”

Runners of all paces know this truth: the pain cave is uncomfortable. But research, elite runners, and coaches suggest that you can improve your relationship with your own pain cave, which can lead to improved performance.

Ready to spelunk? Let’s dive in.

The Science of Pain

A plethora of factors influence where and when a runner enters the pain cave, and what it feels like to be there. Perhaps it feels like breathing hard with heavy muscles and sapped energy. Your mind may chirp or vision narrow. Whatever the exact sensations, they’re caused by a web of processes in your mind and body. In general, pain is simultaneously a physical and psychological experience, influenced by an individual’s past, present, and anticipated future. It’s also personal, shaped by biological, psychological, and social factors. It can serve in an adaptive role, but it also can cause harm—hence, our love/hate relationship with it as runners.

The nervous system, which includes the brain, spine, and nerves, is integral to processing pain. Sensory receptors called nociceptors register location and intensity of pain. Essentially, your body is constantly monitoring external and internal pain in tandem. Your body works to maintain homeostasis, or balance. The goal? Adjust conditions (say, in the gastrointestinal tract or blood) and stay alive. Meanwhile, the brain is registering memories and fear, which dictate emotional responses to whatever pain you’re feeling.

South African exercise scientist Tim Noakes has dubbed the brain the “central governor,” aka the micromanaging boss or overprotective parent who anticipates physical and psychological harm and tries to keep you safe from it.

Another theory, from researcher Samuele Marcora, focuses on the brain’s perception of effort and a human’s motivation to tolerate that effort. Basically, how much suffering can you tolerate? As Marcora wrote in the Encyclopedia of Perception, rate of perceived exertion (RPE) correlates to physiological strain, such as heart rate and blood lactate concentration, which depends on workload (speed, intensity), the athlete’s fitness and health (including nutrition and hydration), and environmental factors (temperature, altitude).

For runners, the higher the RPE, the more likely you’ll find yourself spelunking in the pain cave. Think: hard workouts, races, or days when lifestyle factors like stress and sleep make everything feel tough. Whether athletes persist in intense activity close to maximal oxygen uptake or are pushing their endurance limits, they experience internal and/or external pain.

Professional runner and coach Corrine Malcom, who set the Fastest Known Time (FKT) on the 171-mile Tahoe Rim Trail in 2020, attributes much of the pain cave to the body trying to keep you alive with protective mechanisms: Muscular pain from hot spots (friction in your sock), cramping (the perfect storm of neuromuscular fatigue, fitness, and hydration woes), and nerve and/or tissue pain. “Some of this is caused by strains and/or micro damage to your muscles, inflammation being present and pressing on nerves, and the increasing neuromuscular fatigue that can cause an imbalance in the contraction and relaxation cycle of your skeletal muscle tissue,” she says.

And as pro runner Nia Akins, a two-time NCAA runner-up in the 800 meter, learned on the first day of nursing school: “The definition of pain is relative.” Pain tolerance varies from person to person and is related to mood, feelings, and attitudes. Research suggests that coping skills, self-efficacy (one’s own judgment about how well one can handle something), and even fear of pain also contribute to processing pain.

It’s hard to replicate the pain of running a race (see: adrenaline) or an epic workout in a research lab, but evidence suggests that athletes have higher pain tolerance than non-athletes. “In studies looking at pain tolerance, generally by making someone contract their muscles over and over again or submerge a limb in freezing water, both the trained endurance athlete and the untrained counterpart actually register pain at basically the same point—same number of contractions or time submerged in cold water,” Malcolm says. “What is different is the endurance athlete keeps going. They keep doing the exercise. They keep their limb in the cold water. They’ve trained themselves, possibly without knowing it or acknowledging it to be uncomfortable.”

Precisely because we each have our own unique experiences of what is tolerable or acceptable and what isn’t, it can be hard to distinguish between injury pain and the pain cave, says Ellie Somers, doctor of physical therapy and run and strength coach. To help runners navigate this, Somers recommends asking yourself: “Is this OK with me? Is what I’m feeling acceptable right now, and can I endure more of it to finish what needs to get done?”

With that exception, she sees benefits to people being tolerant to pain. “Sometimes you never really know where your limits are until they break,” Somers says.

Don’t confuse “the pain cave” with “the wall” or “struggle bus.” Hitting the wall feels how it sounds. Coach Corrine Malcolm describes it as “overdrawing your glycogen or energy account. It’s that empty leg feeling because they are not getting the energy supply they need.”

The “struggle bus” is when the wheels fall off—the aftermath beyond the wall. Maybe, Malcolm says, “You messed up your nutrition and your gut is throwing a tantrum, or you’ve messed up your pacing and now you are kind of limping it in. Each of these things could put you in the pain cave, the pain cave is a thing you are actively managing. You are engaging in whatever has gone wrong, or hasn’t gone wrong, and it just turns out that running really long is uncomfortable at some point, even when things are going right.” Strong runners can avoid the struggle bus with Malcolm’s acceptance vs. avoidance mindset.

6 Ways to Suffer Better

Athletes and coaches agree: the first step in facing your pain cave is practicing discomfort. That’s one point of workouts. The grind of high volume and searing burn of speed work prepares both body and mind for harder bouts. “Repeated exposure helps to de-threaten the experience because you know what to expect,” says Somers. Here are six additional tips for improving both fitness and resolve.

Find Fast Training Buddies

Getting pulled along by friends takes the guesswork out of pacing or sticking with a higher intensity. (See: Pacers at track meets who are paid to push races to a certain pace!) Use social incentive to practice speed, endurance, or any specific effort.

Adjust Your Comfort Zone

Runners create comfort zones, and we tend to take actions to protect ourselves within that zone. The good news? Our brains are trainable. Scientists call this neuroplasticity. Start by journaling or keeping a training log to identify your physical and mental boundaries; how might you approach redrawing them, physically and mentally? (A coach or sports psychologist or even therapist can also help with this.)

Visualize the Cave

What does your pain cave look and feel like? How might you remodel it to tap into your own potential? “I [used to] imagine a comfortable chair where all I had to do was sit there and ride out the storm. When I go in now, I imagine grabbing a chisel and heading to the farthest back portion of my cave to work on making it bigger,” says Dauwalter.

Embrace Positivity

“By thinking of the pain cave as a place you want to get to instead of a place to avoid, it can help a lot,” says Dauwalter. “Make it a place of celebration. This is what you were working toward with all your training. This is when you get to see what’s possible.”

Practice Acceptance

Malcolm believes pain tolerance is increased by mindfulness techniques that focus on acceptance of the discomfort over avoidance of it. “When something goes wrong, I address it and I make what changes I need to in order to keep moving,” she says.

Run the Mile You’re In

Focusing on where you are, not how much is left, could stymie your brain’s anticipatory regulation, a negative nervous response. In races, Akins often breaks up the 800 meters into 200-meter increments, granting herself a fresh start with each segment. Another idea: Tap your pointer finger and thumb while counting to help bring your attention to the present during a tough moment in the pain cave.