The Social Stress of ‘No-Pain No-Gain’

Why following the herd is more likely to result in injury, disease and burnout.

By Philip Maffetone and Rik Scarce

This article brings together the combined perspectives of a sports clinician (PM) and a professor of sociology (RS), both of whom have shared the observation that the no-pain, no-gain mindset, born out of economics, and with the potential to cause undue stress, is not unique to the exercise community but endemic to society as a whole. Likewise, related physical, biochemical and mental-emotional stress conditions, from sports injuries to heart attacks, are also not unique to groups of athletes or patients but are observed broadly across society, occurring at very similar rates.


Mention the popular mantra “no pain, no gain” to a group of exercisers and none will bat an eye. Search the sociology databases, however, and this phrase will be found in many other categories, from ethics research and international relations to research on capitalism. In a real sense, “pain” would seem to result in social “gain” in ways far beyond exercise.

In fact no pain, no gain is such an accepted mindset that few will dare question it. For many the brainwashing begins early, often in middle school PE class, where we are trained to believe that physical fitness is something to be gained only through painful workouts. From a societal standpoint this develops into a herd mentality and is also applied to other areas of life, from education to work ethics and even to our relationships with others.

The sociological and social-psychological literature notes that individuals who exercise are viewed favorably by others, and are seen as possessing qualities such as self-confidence and self-directedness. Those who exercise are viewed as people who get things done and accomplish tasks dependably. Yet we overlook the fact that athletes also get injured, sick and can develop the same serious conditions that appear in sedentary individuals, and at surprisingly similar rates. Cardiovascular and other disease risk factors, for example, can rise in athletes just like in couch potatoes, and can lead to heart attacks or other end-stage conditions.

These observations contradict the no-pain, no-gain cliché. Exercise at the cost of great physical stress may backfire; what many think of as behaviors that keep us healthy and increase longevity — running or biking great distances, large doses of “hill repeats” or intervals in the swimming pool — can actually result in the opposite. The adverse results can range from injury to disease to chronic ailments. Consider retired Olympic marathoner Ryan Hall’s well-publicized low testosterone levels and other serious conditions experienced at a relatively young age — in his 30s. Obviously, overtraining can lead to critical personal costs.

To move from exercise and its narrow effects to a broader outlook, there is a larger social causation viewpoint for the no-pain, no-gain attitude. This hypothesis has plenty of evidence in social theory (and empirical scholarship) to justify it. For one thing, this theory that we must put something “on the line” (subject our brains and bodies to pain) to get a “return” (fitness) smacks of a risk-reward worldview. More generally, this distorted way of thinking holds that we must endure hardship for good things to happen to us. But just how far are we willing to go, and are we prepared to sacrifice health for these gains?

The Economy of No-Pain No-Gain

Risk-reward and hardship rhetoric are grounded in the capitalist profit-based economic system, which is geared toward providing life’s basics, and for some so much more. Since capitalism is not globally universal, it holds that not every culture shares these same outlooks. In fact, the American tradition of “no pain, no gain” did not start with Jane Fonda workout videos or the running boom of the 1970s. It actually may have been developed much earlier by Ben Franklin. This Founding Father was one of the early philosophers of capitalism and wrote about how to succeed in a capitalist society. Franklin’s autobiography is so important in this regard that more than a century ago sociologist Max Weber used it to trace the origins of our economic system to strains of thought in Protestantism. It’s easy to see what motivated Franklin’s attraction to no pain, no gain; whenever one invests in a new business, there is the chance of failure, along with the potential for great success. (Some even trace no pain, no gain back to ancient rabbinical texts.)

In the conclusion of the book where Max Weber pointed to Franklin as the paragon of the capitalist ethos, Weber argued that capitalism was creeping into every corner of our lives. He saw us at risk of becoming trapped in a “steel shell,” encapsulated by economic thought that dominates even non-economic aspects of our lives. One way to break out of this human-created shell is to resist the kind of economic rhetoric that leads to our entrapment in the first place. Otherwise, stress in many forms can impair us. For some “hard work,” and even “workaholism” is viewed as a positive formula for success in business and in finances. For others, running, cycling, and other forms of working out are great ways to break free of this steel shell, if only for a short time. But how we pursue those activities is key.

The Big Picture

Why should economic logic guide what we do outside of the economic sphere? That was the underlying question for Weber.

Not only is no pain, no gain a broad concept that applies to all of society, but it also is applied, along with unique pains and gains, to isolated groups, such as runners or other athletes, or even non-athletes. Runners and couch potatoes, for example, form distinct groups with attitudes and diverse lifestyle habits that influence how and where they fit into society.

Because human behavior is sensitive to and strongly influenced by our social environment, as advertisers well know, no pain, no gain remains a prevalent sales pitch used to influence the general public’s mental and physical health, and fitness too.

There are many examples of how no pain, no gain harms us. They include, for example, heart attacks, a condition expected in out-of-shape, unhealthy individuals at high risk for cardiovascular disease. Yet, the same cardiovascular risk factors, even heart attacks themselves, occur in athletes at about the same frequency as in those who are sedentary.

This example, along with others mentioned below, first became evident to one author (PM) during decades of private practice, in which the patient population consisted of both athletes and non-athletes. These patients were a broad representation of the population. While they were of above-average income and education, had better health insurance, and other socio-economic or demographic differences, these patients shared the same chronic preventable diseases. What became evident was that the rates of many physical, biochemical and mental-emotional conditions were the same in both groups. The common denominator was stress. In recent years, published scientific studies have supported many of these clinical observations.

Below are some examples of these physical, biochemical and mental-emotional stress-related “injuries” prevalent in society as a whole that cross the supposed boundaries among distinct groups.

Heart Disease

The increased risk of heart disease and death appear in both competitive athletes and otherwise similar non-athlete age-groups. A 2012 study published in the New England Journal of Medicine looked at running events between the years 2000 and 2010 and found that of the 10.9-million runners who participated in marathons and half-marathons in the U.S., 59 suffered a fatal heart attack while participating, an incidence rate of 0.54 per 100,000 runners. The authors state that there is no lower incidence of sudden death in runners compared to the general population.

Asthma

According to the Centers for Disease Control and Prevention, the prevalence of asthma in the U.S. population in 2013 was 8.3 percent in children and 7 percent in adults. By comparison, in 2012, Kippelen and colleagues collected data from athletes in the previous five summer and winter Olympic Games, showing that about 8 percent had asthma.

Depression

A 2013 study in Germany (Nixdorf et al.) showed that the prevalence for depressive symptoms in elite athletes was 15 percent, comparable to that in the general German population. (Depression is a common component of the overtraining syndrome, a condition often found in athletes.)

Injuries

Mild to moderate pain-related physical injuries are the most common health problems in both athletes and non-athletes. These include sprains and strains, “pulled” muscles, joint pain and others. Most are non-traumatic. In a given year, more than 50 percent of athletes may suffer a training-related injury, even in non-contact sports: likewise, for those engaged in aerobic dance, group calisthenics, strength training, and who use gym equipment. Pain is the most common associated symptom of these injuries. Despite the difficulty of gathering data for comparison, non-exercise-related unintentional injury rates among the general public are not dissimilar. An Institute of Medicine report states that 100 million Americans have physical pain conditions. Certainly the majority of these individuals would not be athletes or even regular exercisers. Pain is also associated with inflammation, and both are two key components of virtually all injuries.

A common denominator between sports injuries and the ones that occur in sedentary people have to do with predisposition to injury. Neuromuscular imbalance may precede the first sign or symptom of a non-traumatic injury, leading to low back or knee pain, carpel tunnel syndrome, or other conditions — in athletes this imbalance may be exacerbated by overtraining and in the sedentary person by a sudden bout of spring cleaning or even inactivity, although in many people no clear trigger can be ascertained. Essentially, the mechanism of body breakdown is similar: Neuromuscular imbalance with ensuing joint dysfunction, inflammation and pain is nearly the same in most non-traumatic injuries.

Another comparison can be made between trauma patients seen in the emergency department (due to a motor vehicle collision, head trauma, serious fall, etc.) and an athlete training hard and competing who also induces a considerable amount of non-contact trauma. “At the cellular level, trauma and exercise resemble each other, with inflammation being the common response,” says Dr. Catherine Dudick, trauma surgeon at AtlantiCare Regional Medical Center in Atlantic City, New Jersey. “While inflammation drives healing, too much can also drive further injury.”

Social Wellness

In many ways, we are only as healthy as the world around us, with social influences affecting our behavior and habits regardless of whether one is an athlete or couch potato. It’s the reason worker wellness programs are still unsuccessful most of the time — the spectrum of people who make up large and small companies are a part of the same unhealthy society. A particular wellness program may influence individual people, but as a whole, a group of workers is also a reflection of society.

No pain, no gain may be considered an example of herd behavior. It’s quite possible that physical injuries, asthma, heart attacks are examples of the biological end-result of following the mindset of the masses.

Consider the start of a marathon. For many marathoners, subjective factors at the start of a race, especially those of a psychological nature, can interfere with their abilities to avoid faster paces early in the race. Whether in the lead pack or back of the pack, marathoners are more likely to follow other runners in the initial stages of the race and run too fast rather than follow their own perceived abilities. This herd mentality is seen not only in marathon runners but in other endurance sports and on other levels of society — making choices by following others is easier.

While, individually, we have responsibility to improve our own wellness, most people are significantly influenced by social forces in the form of fitness trends, advertisements, food costs and availability and, of particular concern, physical, biochemical and mental-emotional stress brought on by life in modern society — life increasingly characterized by existence in Max Weber’s steel shell.

At the individual level how does no pain, no gain influence us? Through a well-understood physiologic brain-body mechanism.

The brain-body connection is not just some philosophy but a real neurological and hormonal mechanism that allows all parts of us to biologically adapt to the various physical, biochemical and mental-emotional stressors we face each day. It’s called the HPA axis (hypothalamic-pituitary-adrenal) and it’s how we cope with stress. If the stresses are too great to recover from each day, they hurt us. The downstream problems include pain, inflammation, physical injuries, heart disease, asthma, depression and other mental illnesses, and various signs and symptoms.

The behavioral notion of no pain, no gain stimulates the HPA axis with too much frequency and intensity. For athletes, pushing hard enough without sufficient recovery may cause overtraining syndrome. For hard-driven business owners, executives, health practitioners or other professionals, the parallel manifestations include burn out and costly human errors. The same is true for train, bus, and auto drivers, airline pilots and virtually anyone.

Yet, each of us does have control over the HPA axis. The mechanism begins in the brain, and humans have the potential to adjust our way of thinking and acting to better survive, regardless of what the rest of society is doing.

Many know the no-pain, no-gain mantra and believe athletes are invincible — tough, hardy and strong. Prevailing emotions, shaped by forces as diverse as media representations and peer groups, say pushing past where the brain and body want to go, regardless of what’s in the way, is how to get to the finish line. The loneliness of the long distance runner, the solitude of the weight room, the isolation of long stretches of empty open roads. Making lots of money so we can retire early. It all makes us gainfully stronger. But at what price of pain?

Bibliography

Schmidt JF, Andersen TR, Andersen LJ, et al. Cardiovascular function is better in veteran football players than age-matched untrained elderly healthy men. Scand J Med Sci Sports 2015; 25: 61–69.

Prasad A, Popovic ZB, Arbab-Zadeh A, et al. The Effects of Aging and Physical Activity on Doppler Measures of Diastolic Function. Am J Cardiol. 2007; 99(12): 1629–1636.

Gray S, Finch C. Epidemiology of Hospital-Treated Injuries Sustained by Fitness Participants. Research Quarterly for Exercise and Sport. 2014;86(1):81-87.

Nixdorf I, Frank R, Hautzinger M, Beckmann J. Prevalence of Depressive Symptoms and Correlating Variables among German Elite Athletes. 2013. J CLIN SPORT PSYC; 7(4):313-326.

Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The National Academies Press, 2011.

(100 million Americans have physical pain conditions.)

Kippelen P and Anderson SD. Assessment and prevention of exercise-induced bronchoconstriction. British Journal of Sports Medicine. 2012; 46(7): 471–476.

Behr P.  The “Iron Cage” and the “Shell as Hard as Steel”: Parsons, Weber and the Stahlhartes Gehäuse Metaphor in the Protestant Ethic and the Spirit of Capitalism. History and Theory. 2001; 40(2): 153-169.

Banerjee AV. A simple model of herd behavior. Q J Econ. 1992;107(3):797-817.

18 Comments

  • P solon says:

    This heroic idea of enduring and overcoming pain starts w the Greeks–just read what we have of the first tragedian Aeschylus. His main theme in his 12? surviving plays is that wisdom comes mainly/only from having suffered. Ask also the general/tragedian Sophocles in accord: Oedipus doesn’t learn and gain self knowledge till he sufferes horrible physical pain and worse psychological. Even bf with homer Achilles has a choice given to him: go to war against Troy and die but be a hero, or stay home and have a normal life. We know his choice.

    It all started early. The idea started at the start of lit.

    • P solon:

      I agree with the facts you lay on the table, but those aren’t the only facts to lay down. The problem is that “no-pain, no-gain” isn’t a Greek idea. The idea that you need to go through physical trials and endure great hardships is a Greek idea, but that isn’t “no-pain, no-gain.” “No-pain, no-gain” is the idea that anything that doesn’t constitute pain doesn’t constitute growth. And this is why overtraining is so rampant in the athletic world. Put another way, if the Greeks were doing “no-pain, no-gain” as we understand it today, Oedipus would’ve probably gotten burned out before he gained that self- knowledge, and Achilles would’ve washed out before he had a chance to die for glory.

      Also of note: Achilles was the son of a minor goddess. I wouldn’t follow in his footsteps unless you’ve got that going for you.

      Here’s a better option: Follow the lead of “wily Odysseus.” He understood, above all, his limitations. He knew without a doubt that all his glorious, kingly resolve would mean nothing when faced with the enchanting songs of the sirens. So what did he do? He acted according to his limitations. He filled his oarsmen’s ears with wax after he’d ordered them to tie him to the mainmast of his ship. That way, they’d be able to sail through their songs without being taken in.

      This article is essentially a call for that. In this metaphor, “no-pain, no gain” is the call of the sirens: “come here and you’ll enjoy endless pleasures (or whatever)” turns into “do this and you’ll be forever fit and strong.” The fact of the matter is that people do take it that way, or overtraining as the modern phenomenon it’s become would simply not exist. We have to understand that what “no-pain, no-gain” has done for a lot of us is to push us way past our limits—which is why we become ill, injured, and overtrained. To put it in perspective, neither Odysseus nor Oedipus were pushed past their limits: if they had, they would’ve washed out. They might have been way out of their comfort zone, but not beyond their limits. If they had been pushed beyond their limits, we’d be talking about 2 other guys who did make it (or at least their stories would have had very different morals).

      And that brings out one of the many associations of “no-pain, no-gain”—the whole “push past your limits” thing. People who are highly successful athletes have internalized that it is a lie. The best way to know if you’ve pushed past your limit is if you’re ill, injured, overtrained, or dead. If the above do not apply to you, you may be outside of your comfort zone, but squarely within your capabilities. And that’s where Oedipus and Odysseus lived throughout their tribulations. Achilles succeeded in pushing past his limit (in this case pushing his luck): that’s why he’s dead.

      • Petr Judl says:

        Great (and important) article indeed. And this comment of yours, Ivan, what an immense pleasure to read such an insightful response to a comment! Loving the comparisons.

  • Ben Wieczorek says:

    Fantastic! So true, frequency and moderation, not nearly as sexy as do or die !?

  • Andrew Fleming says:

    So is the intensity meaning too much high intensity? if i have a week mainly consisting of long distance (Medium for some, possibly short…..) runs of 6-12 miles at low intensity, am i more/Less at rick to the said ailments than a guy/girl who trains fartlek everyday? I must admit if i have a week of swimming and running taking it easy i feel good but when im doing tough sessions in the gymi can feel extremely deflated by the end of the week, loosing motivation to train

    • Andrew:

      Yes, it means too much high-intensity. However, there is such a thing as too much low intensity training, too. For example, walking, which often occurs at heart rates much lower than MAF (which is our threshold for “low-intensity”) will tire you out too much after a certain point. So it’s the same with low intensity training. But as a rule of thumb, you can run about 5-10 times as many miles at a low intensity than you could at a high intensity (or more, if you’re highly trained).

  • Seamus says:

    Brilliant

  • ANDREAS WILLIAMS says:

    What an excellent article. Its a shame that their aren’t more people pushing Phil’s knowledge. Often it’s too late for athletes and training non athletes, as they acquire this knowledge after serious injury and overtraining. Id like to see Phil discuss and share his ideas on how overtraining syndrome can be overcome if it turns into Chronic Fatigue Syndrome. This is barely discussed anywhere with any coherence or gravitas, given the seriousness of the condition it would be very welcome for a lot of people. Brilliant writing, thanks for your insights.

  • Frank says:

    Hi Ivan, Enjoy reading your responses to all the questions and often learn as much from them as the original article.
    I am currently doing MAF base training purely for the enjoyment of it and have no interest in racing anymore. But am still interested in getting faster and healthier. I was wondering if after I had built a large aerobic base if I should add some anaerobic training as I won’t be getting any at all from racing. Something along the lines of the 80/20 rule ? I notice they say some athletes can get by solely on MAF training but of course they pick up some anaerobic work from racing which I will miss out on.
    Thank you

    • Frank:

      Yes. So your best bet is to use the MAF Test as a go/no-go test for anaerobic training. If your MAF speed continues to rise month by month, it’s a good idea to include 10-20% anaerobic training in your regimen. But if your MAF speed falls or plateaus for 3 months, eliminate all anaerobic training.

      • Frank says:

        Thank you Ivan. Excellent advice as always. I can’t believe how fast the aerobic system can develop. I just got back from a 5 month holiday where the only exercise I did was a little walking. My first outing on my bike 6 weeks ago at MAF averaged 18kph. Today I averaged 27kph. Amazing return on investment.

  • Bob Kaill says:

    Can one download the article as a pdf?

  • Roman says:

    I’m a little late for the discussion but I feel the need to comment on the risk of heart disease.
    IMO, you can’t really compare the incidence rates because of the different causation. While the risk for heart disease in athletes mainly stems from myocarditis, the cause for heart failure in sedentary populations is way more likely the result of the multiple causes of cardiovascular disease (eg. hypertension, angina, peripheral artery disease etc.), which certainly increases with a sedentary lifestyle and age. However, I would argue, that there is no population of elite athletes in the age group where the risks faktors of a life long sedentary lifestyle really start to kick in.
    It’s as if you compare the death rates caused by lung disease between smokers and mountaineers in their 30ies. The ratio of smokers dying of lung cancer is probably lower than mountaineers dying due to high-altitude pulmonary edema at that age.

    • Roman:

      The problem is that the risk of heart disease in athletes doesn’t just stem from myocarditis. The cardiovascular disease associated with insulin resistance and the metabolic syndrome has been found in athletes of all levels due to the fact that the endocrine, immune, and autonomic responses to the stress of overtraining is substantively the same as the endocrine, immune, and autonomic responses to insulin resistance. Effectively, we can say that while an active way of life is protective to the types of heart disease found in sedentary individuals, an excess in activity—as one may be pushed to by the philosophy “no pain, no gain”—may be in fact conducive to similar dysfunctions (cardiovascular, endocrine, immune) to those you find in the metabolic syndrome.

      We discuss both phenomena as well as the correspondence between them in our white paper on carbohydrate intolerance.

  • Eddie Urcadez says:

    Ivan,

    I have been on a low carbohydrate diet for over 4 years now and started MAF training one year ago with great results. My MAF test kept improving over time. As I continued MAF training I begin to notice leg swelling. At first it may have been every 3-4 days but later it increased to everyday, worst at the end of the day. I noticed that a little higher intensity workouts helped reduce the swelling. Because of this I stated incorporating more higher intensity workouts and have noticed a reduction in swelling. I would like to maintain a MAF method of training but am worried about the inflammation and swelling. I have notice my resting HR decrease after I started MAF. Would that have anything to do with it. I’m 54 and have been involved in endurance cycling for over 25 years. The incidences of leg swelling has only started since I incorporated the MAF method in my training.

  • Walter Wood says:

    Excellent article. A wonderful reminder that there is more to life than being the fittest corpse in the making.
    Mr. Rivera, or doctor as the case maybe, I have a personal question I hope you will answer. I am a 63 year old male in good physical condition with an aortic valve replacement which make my pulse run high. As per the MAF protocol I should exercise at no more than 117 bpm. At that heart rate I don’t even breath fast. At a “play” rate my bpm is in the mid 130s. What to do?

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