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.
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.
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.
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.)
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.”
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?
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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.)
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