About the Author
Albertus Roux is a sports scientist and ultra-trail runner specialising in endurance performance and human physiology. Drawing on scientific research, coaching experience, and years of ultra-distance mountain running, his work focuses on resilience, discipline, and the mental and physical demands of endurance sport. He helps athletes improve performance and unlock long-term potential through evidence-based insight and real-world experience.
Why do some ultra-trail runners seem able to keep persisting long after their body and mind have started shouting at them to stop? It is easy to say they are simply “tougher” or have a higher pain tolerance. But the science suggests something more interesting: elite ultra-endurance athletes may not just tolerate pain better; they may relate to pain differently. For us, this matters because pain and discomfort are not extreme in our sport, they are inevitable and sort of a twisted rite of passage. The real question is not whether discomfort will arrive, but how we frame it in our minds. Let’s look at this recent review on the topic.
Why this study matters
Ultra-trail running is unlike any other sport, where the main driver is not always your physiology. Being a researcher in this topic has opened up my eyes to the wide variety of attributes that you need to be successful, almost all of them being trainable. This review matters because it looks at the mental and psychological strategies that help ultra-endurance athletes persevere in spite of extreme pain. For coaches and runners, this is important. We should not train athletes to avoid discomfort, but we can help them build skills to interpret, manage, and respond to it more effectively.
Reasons for enduring pain
Pain modulation in ultra-endurance athletes
The paper starts by reminding us that some factors are relatively fixed, but many are trainable or modifiable. There is some evidence that endurance athletes are exceptional at pain modulation through inhibiting the neural pathways associated with pain by using a mix of endogenous mechanisms. Now, it’s not clear whether this is trainable or whether people with this predisposition naturally gravitate towards endurance sport, but this is explored later. This can be seen as either:
1) Positive, where it allows for breakthrough performances and more training volume.
2) Negative, where they override red flags for injuries and train through them.
Ultra athletes have reduced pain avoidance behaviours (they seek out discomfort), and pain related anxiety. These are likely built through extensive endurance exercise. By micro-dosing pain and discomfort on a regular basis generates an expectation and acceptance of pain. This allows the athlete to cope with the severe physical and emotional unpleasantries of prolonged events.
Interoception
The theory is that pain is both sensory and emotional state that motivates humans to protect themselves from perceived harm. The sense or feeling of the physiological state of the body is called interoception (i.e., “how do I feel?”). The disruption of interoception results in chronic pain where people “feel” there is something wrong with their body even if there might not be something objectively wrong. This will trigger pain avoidance, resulting in changes in behaviour such as changing running gait. The enhancement of interoceptive accuracy can be honed (again) with chronic physical training, where athletes can choose to either manage or dissociate from these signals, allowing them to transcend physical limits. However this does not mean athletes ignore these signals, they are masters at interpreting them consciously or unconsciously. This mind-body awareness can only be achieved through progressive and planned physical hardship.
Self-efficacy and mental toughness
Mental toughness is described as psychological resilience: “the ability to cope with various stressors, including pain and adversity”. This goes in hand with self-efficacy, essentially how well can you handle and manage the situation you are in. It’s unclear currently whether these attributes are of nature or nurture, but its logical to assume that the more you put yourself in stressful situations, the better you become at managing your response to them.
Locus of control
Locus of control refers to whether someone feels they have influence over what is happening to them. The paper suggests more successful ultra endurance athletes have a stronger internal locus of control, are more likely to use active coping strategies, and feel less emotionally overwhelmed by pain. Whereas people with an external locus of control are more likely to avoid pain and are less likely to engage in behaviours that are perceived to be painful. More successful athletes are proactive in their pain coping strategies, and therefore “feel” like they are in control of the situation.
Adaptive coping strategies
The review highlights athletes using adaptive strategies such as pacing, visualisation, self-talk, and mindfulness were better at managing pain than those using maladaptive practices such as pain catastrophising, rumination, and avoidance. This all falls into pre-race mental preparation. Acceptance of pain, visualising it vividly, and taking satisfaction from it are core adaptive strategies that can help you deal with the inevitable.
Mindful states
Mindfulness appears in the paper as a useful way of regulating attention and emotion. Rather than fighting discomfort or becoming consumed by it, athletes can notice what is happening and redirect attention towards useful cues: rhythm, breathing, posture, cadence, footing, or the next runnable section. The important nuance is that mindfulness is not the same as ignoring pain. It is a way of observing it clearly enough to respond well.
Spirituality, resilience, and social bonding
The final theme is the meaning athletes attach to pain. Ultra athletes commonly describe intense bodily suffering as “beautiful suffering”, and feeling a new level of consciousness and joy in their life. Díaz-Gilbert referred to ultra runners as “ascetic athletes” who defy normal limits of human tolerance, likening them to the early Christian ascetics (monks) who experienced “exhilarating suffering and joy” as a result of their self-inflicted torture.
Wherever you draw your energy from, its apparent that the mindset of ultra athletes incorporates an expectation, an acceptance of, and even pleasure, in extreme bodily discomfort and hardship. Where does this strange behaviour come from? When ultra athletes are asked this, they refer to pain as a ritualistic transition process or rite of passage. In this way, pain narratives provide a unifying experience within a social group (the ultra-marathon tribe if you will). This gives reason to the madness, not only do these athletes expect pain, but they actively seek it in search of this “beautiful suffering” and unification.
My interpretation
What surprised me most was not that ultra-athletes are good at suffering. Anyone who has spent time around ultra-trail runners already knows that. What stood out was the idea that pain coping is not only about toughness. It is about interpretation. The same sensation can mean very different things depending on context. Heavy legs in the final hour of a key long run might feel like progress. The same heavy legs during an easy week might feel worrying. The signal is similar, but the story attached to it changes the response.
This aligns strongly with coaching experience. Many runners do not fail because they are physically incapable. They struggle because discomfort surprises them, scares them, or arrives earlier than expected. When athletes know what certain types of discomfort feel like in training, they can meet those sensations with more confidence on race day. That is why specific preparation matters. Long climbs, technical descents, heat exposure, night running, and nutrition practice are not only physical sessions. They are also opportunities to teach the brain, “I have been here before.”
That said, there is a limitation we should take seriously. Reframing pain is useful, but it can become dangerous if athletes learn to override every warning sign. Ultra-trail culture can sometimes glorify pushing through at all costs. That is not resilience; that is poor risk management. The goal is not to become numb or reckless. The goal is to become more skilful at listening. Some discomfort is part of the game. Some pain is information that needs action. Good coaching helps athletes learn the difference.
Practical takeaways
- Practise discomfort before race day. Use long runs, climbs, technical trails, and race-specific sessions to build familiarity with fatigue.
- Name the signal. Is it muscle fatigue, breathing discomfort, hunger, heat stress, foot pain, or fear? Clear labels lead to better decisions.
- Use active coping tools. Try short self-talk cues, mantras, visualisation, pacing adjustments, and breaking the route into smaller sections.
- Build realistic expectations. If you expect an ultra to feel easy, pain will feel like a problem. If you expect hard patches, they become part of the process.
- Know your red flags. Sharp, worsening, one-sided, or mechanically changing pain deserves attention. Resilience includes knowing when to adapt or stop.
- Train the mind with the body. Every hard session is a chance to practise calm decision-making under pressure.
6. References
Paley, C. A., & Johnson, M. I. (2025). Human resilience and pain coping strategies: A review of the literature giving insights from elite ultra-endurance athletes for sports science, medicine and society. Sports Medicine, 55, 2137–2146.
FAQs
Why do ultra runners tolerate pain better?
Ultra runners may learn to interpret and manage discomfort better through repeated exposure, training, and mental coping strategies.
Can pain tolerance be trained for trail running?
Yes. Long runs, hill sessions, technical trails, pacing practice, and mental skills can improve how runners cope with discomfort.
What is interoception in ultra running?
Interoception is the ability to sense internal body signals like fatigue, hunger, breathing, effort, and pain.
How can trail runners manage pain during an ultra?
Use pacing, fuelling, breathing, self-talk, mindfulness, and small goals to stay calm and make good decisions.
Is it safe to push through pain in ultra running?
Not always. Normal discomfort is expected, but sharp, worsening, or one-sided pain should be treated as a warning sign.