Sharyn O’Halloran

The motto “no pain, no gain” drives athletes to push through the intense discomfort of strenuous physical exertion to the nirvana of endorphin induced bliss on the other side.  But many times, the pain doesn’t stop.  No matter how much grinning and bearing you do, the pain becomes chronic and may even intensify.  It is at these times that you need to re-evaluate your training program and seek the advice of a health expert.

Women, unfortunately, have difficultly following this common sense advice for two conflicting reasons. First, women are slower to seek medical attention for an injury than are men.  They will wait until the pain becomes simply unbearable (I know, I’m one.) Second, when women do seek medical attention, doctors are less likely to treat the pain itself than males with the same aliment.  Female pain, unlike male pain, is viewed as psychological not physiological.  In both cases, a women’s pain goes untreated.

What is the pain gap?

Women and men experience pain differently.  Studies repeatedly show that across all disease categories women feel more acute pain.  A Stanford University study examined gender-related differences in pain intensity as reported on 1-to-10 scale, in which a zero stands for “no pain” and 10 for “worst imaginable.”  The research found statistically significant higher pain scores for female patients across all categories. Moreover, the reported differences were clinically significant: a pain-score improvement of one point is what clinical researchers view as indicating that a pain medication is working.

A recent article in the Wall Street Journal summarized over 15 years of clinical studies, reaffirming the findings that women are both more likely to develop chronic painful conditions and to report greater pain than men with the same condition. Women also express more acute pain than men even after the same surgeries, such as wisdom tooth extraction, gall bladder removal, hernia repair and hip and knee surgery.

In addition, women repeatedly exhibit lower thresholds (report pain at lower levels of stimulus intensity) and tolerance (can’t bear intense painful stimulation as long) for various types of pain.  For example, while men and women have comparable thresholds for cold and ischemic (decreased blood flow) pain, women have lower pain thresholds for pressure-induced pain than men. Similarly, women tolerate less heat and cold pain than men, but tolerance for ischemic pain is comparable between men and women.

Why the difference?

While hormones play a role, part of the problem is behavioral. Women usually wait longer to seek medical intervention like surgery. In contrast, men tend to seek surgery before their pain becomes extreme. The surgery itself is equally beneficial for both sexes, but because a woman typically has more advanced disease by the time she gets surgery, the result often isn’t as good.

A 2008 Canadian study also shows that medical professionals respond differently to female and male pain.  Even when women  seek medical help, they are less likely to be treated.  For example, the odds of a surgeon recommending knee replacement were 22 times higher for a male patient than a female. Moreover, when expressing symptomatic pain, women are more likely to be sedated while men are more likely to receive pain medication.

What to do?

1)   Know Your Pain—Log when your pain occurs.  If it is episodic or happens during the monthly cycle, hormones could be at play. If it happens during long runs, changing your workout to accommodate these fluctuations could help mitigate some of the pain.  If it is chronic, seek medical advice.  Knowing when and under what conditions your pain is expressed will help with diagnosis and treatment.

2)   The Obvious is Not Always Obvious—I always assume I know the cause of my pain.  I have an amazing track record: I am always wrong.  While symptoms may be felt like a tight hamstring, the cause may have nothing to do with the hamstring.  In my case, a chronically tight hamstring that would not respond to stretching and downtime was not caused by a muscle pull but by musculoskeletal misalignment.  Go figure.

3)   Seek Medical Advice Early—Don’t wait.  If an injury is not responding to topical remedies seek medical advice early on.  I muscled through my pain and completed a marathon and ultra-marathon under excruciating circumstances.  I probably did more damage than good.

4)   Mix-it-Up –Imbalances in muscular strength and flexibility are typical byproducts of extensive endurance training and a recipe for injury.  Cross training  will help maintain your endurance and strength even while you allow yourself to heal.  Weight training and water aerobics, along with a consistent stretching routine, provide the best defense against repeat injury.

5)   Persistence—The same determination that makes you an endurance athlete is going to get you the health results you want. My podiatrist thinks I have a crush on him because I visit so often.  That may be true, although I don’t date married men, but I insist that he gets my orthotic insoles correct.  Otherwise, there is another good-looking podiatrist just down the block.

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