Pain and Performance, Friend or Foe?

In the box, the hurt locker, the pain cave. Every athlete has ventured to these places countless times to get the most out of themselves during competition, but how much faster can one go by simply saying “shut up legs”, and are there ways get around the suffering?

shut up legs
Image Credit: elliebeanprints.co.uk

We’ve all experienced the burning sensation associated with sprinting to the top of a hill, the back half of a long TT or trying to complete a singular chin-up (cyclists take a good hard look at yourself). The reasoning behind these highly unpleasant sensations is physiologically important for protecting the working muscles as well as the heart.

Every muscle contraction causes minute damage to the cell membranes within the muscle (scary right?), and the more forceful each contraction the more damage occurs (visit the blog on antioxidants for why this is surprisingly useful when it comes to training). This damage to the cells release cyclooxygenase enzymes (you may have heard them referred to as COX) which essentially lead to the brain being told “ow, stop going so hard” and generating that awful sensation we’ve all felt (there’s a few extra steps in this process which you can look into here).

As it happens during a race, athletes don’t tend to be too interested in preventing muscle damage and would much rather go faster, win the race and then worry about the rest later. For this reason, managing pain, whether through fighting it or embracing it, can be a vital skill for competitors to gain an edge over their opponents. Just the act of regular high-intensity training has been proposed to alter pain perception and tolerance. Elite athletes have also been found to have a higher pain-tolerance than non-athletes but a fair chunk of that effect size may stem from those athletes being required to be naturally capable of handling pain just to get to the top of their sport.

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Image Credit: cyclingtips.com

Unfortunately, pain during exercise is a notoriously difficult area to research since pain is subjective. It’s a tough task for researchers to distinguish whether one athlete is hurting more than another, regardless of how epic one’s pain face may be. Two current areas of research have looked at ways to combat pain by either psychological or pharmaceutical means.

The power of the mind

Psychological methods include the athletes either attempting to ignore or embrace the pain. Ignoring the pain, AKA the ‘shut up legs’ approach, usually comes from mental distractions such as focusing on aspects outside the competition (crowd/scenery/etc.) or through mental imagery and positive self-talk (picturing the glory of crossing the finish line first or going to your ‘happy place’).

Embracing the pain, AKA the ‘pain is temporary’ approach, is an almost meditative process which involves accepting that the body is telling you to stop but forcing yourself to keep pushing as the pain of losing for many is greater than the pain of suffering during an event. Unfortunately, the research is still on the fence as to whether these techniques actually provide a significant performance benefit in endurance events.

Another psychological method to manage pain is called ‘end-point manipulation’. In this technique athletes tell themselves to “just make it to the next corner” or “just one more lap” repetitively to squeeze the most out of themselves. Interestingly, studies have found this can work up until a certain point. For example, athletes could be told the finish line was 500m further than they initially thought and could still maintain the same output for the extra distance. However, when the finish line was, say, 1 or 2km further than expected, athletes would ‘crack’ and output would drop significantly.

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Image Credit: Tim de Waele via velonation

The Uncle Dougs

Given the range of painkillers now readily available to the public it’s no surprise that some athletes will also use pharmaceutical means to directly block out the pain. There’s no doubt these are effective in preventing the pain caused by intense physical activity but there’s also some health and performance side-effects of which everyone should be aware.

The common over-the counter painkillers (aspirin, paracetamol, etc.) usually act on the COX enzymes mentioned above. Inhibiting action of this enzyme means that the muscle damage caused during exercise causes significantly less pain for the athlete. This can be acutely beneficial for performance however can cause issues later as a result of the body damaging itself more than under normal circumstances. The fatigue and damage to the muscle fibres most effective for the contractions required can result in recruitment of less effective fibre groups, or just simply damage the muscle to the point where it can no longer contract as forcefully. In short events this may not be a problem but at the end of a long one-day race or in a multi-stage tour the use of painkillers can be more detrimental than beneficial.

The anti-inflammatory effect of many of these pain medications prevents the effective repair and strengthening of muscles post exercise, as discussed in this post. More worryingly, COX inhibitors have been associated with an increased risk of myocardial infarction and stroke. In a situation where the cardio-vascular system is already under serious stress (e.g. intense exercise) this is a risk you may want to think twice about before popping those panadols!

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Image Credit: www.ncbi.nlm.nih.gov/pubmed/30102811

The elephant in the room when it comes to pain in sport, particularly professional cycling, is recently banned tramadol. Tramadol is an opioid medication, the same family as morphine but with around one tenth of the potency. It acts by preventing the reuptake of serotonin, meaning there’s more serotonin that hangs around in the system resulting in a reduced sensitivity to pain. As many will know, opioids do have a number of nasty side effects. Nausea, itchiness and lack of perception of necessary stimuli such as hunger and thirst can provide problems directly on the bike. The highly addictive properties of these medications can result in dependence on these painkillers and cause severe withdrawals or chronic pain when users stop taking them. Knowing this, it’s a surprise the WADA tram ban didn’t come earlier!

Take home messages:

  • Pain is a protective mechanism to prevent damage
  • Elite athletes have a higher pain tolerance than the general population, indicating pain management can benefit performance
  • Psychological methods can be used to manage pain during exercise, though research indicates the benefits to performance are limited
  • Over the counter pain medication can be effective in the short term but may be detrimental in longer events and can increase risk of cardiovascular complications
  • Tramadol and other opioids are very effective at decreasing pain sensitivity but can have serious short and long-term side effects
  • Research provides no clear message as to how athletes can use analgesic drugs while minimising unwanted side effects

Pain is a part of high-intensity exercise whether we like it or not. The mental strength involved in coping with this is often what sets the best apart from the rest. You can be as strong as you want in the legs but often its what’s between the ears that counts. 

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2018 Aus U23 TT Champs. Ventured to some dark places fighting against the pain on the run home here. The pain was intensified when I found I’d finished just 2 seconds off the podium and 15 seconds off the win. Stiff bikkies

 

 

This piece was written during some big travel days involved in getting 50kg of belongings (mostly sunscreen) from Melbourne to Girona. I’ll be based here for the majority of this season and I’m looking forward to some big days on the local climbs to get ready for my first Euro race of the season, Circuit des Ardennes, in two weeks. I’ll certainly be staying clear of the painkillers and from all reports the domestic racing scene in France is brutal so I’m sure to be in for a painful few days. Until then, I’ll keep reading the research papers so you can spend more time on the bike.

Cheers,

Cyrus

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Intra-Session Protein for Performance; Yeah or Nah?

Cycling requires repetitive contractions of big muscle groups for hours on hours, so why isn’t anyone reaching for a protein shake mid-ride?

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Image credit: 926663 via Pixabay

In my time working in gyms I’ve seen some a common occurrence amongst lifters – If someone’s hitting the gym for longer than an hour, a protein shake will likely be in hand between sets. Cycling can have ridiculous demands on the body and it raises the question of whether cyclists should be the ones with a protein shake mid-ride? Not only can cycling be taxing to the body, but, protein itself plays some interesting roles which suggest it could have a positive impact on performance.

  • Protein is a macronutrient (alongside carbohydrates, fats and alcohol).
  • protein can be converted to glucose (the form of carbs the body prefers).
  • protein will be oxidized (burnt) in endurance exercise.

Given these facts, it begs the question of whether mid-ride protein supps would have a positive effect on performance.

To be specific we are asking “what are the effects of intra-session protein supplementation on acute endurance cycling performance outcomes”. We aren’t looking at whether protein makes you recover for the next session or whether protein makes you feel less sore after a ride, etc etc. A bunch of that stuff we might tackle in the coming weeks.

Interestingly, there isn’t a great deal of data on endurance performance and intra-session protein supplementation. Don’t get me wrong searching for “effects of protein on endurance performance” will return heaps, but none of these results look at exactly what we are after.

There is so little out there that I couldn’t find a single paper that compared protein alone to placebo, carbs or carbs+protein. Not a single paper. Confirming my lack of results, a 2014 systematic review didn’t find a single paper on our topic. (Effects of Protein Supplements on Muscle Damage, Soreness and Recovery of Muscle Function and Physical Performance: A Systematic Review YEAR). The lack of research isn’t that surprising. The pathways of energy production in skeletal muscle are well known and, as we’ve seen, carbs are king. Researchers aren’t as likely to look at protein alone as carbs have such a well-documented effect on performance.

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Image credit: jarmoluk via Pixabay

And with this we have an answer to our original question:

Q: “if I want to go faster in a long training ride or a long race should I swap out my carbohydrate sports drink for a protein supplement?”

A: “Probs not, stick with the carbs”

Or you could say “at this stage, it appears that intra-session protein supplementation alone is extremely unlikely to cause any significant improvement in performance. With that said, there are few if any good studies that directly compare protein to other supplements so there is a small chance that it does have a positive performance effect but, as of yet, it is unlikely.”

I did find another question which is relevant.

“What is the effect of intra-session supplementation of carbs AND protein on performance?”

This one has more research. Rather than go through all the papers I found, here is a nifty figure from a review on the topic which we’ll breakdown to look at some of the nuances of this topic. (Is There a Need for Protein Ingestion During Exercise? 2014)

figure 1 cal
Studies investigating improvement in performance with intra-session carbohydrate + protein supplementation compared with carbohydrate alone. White bars are studies that use Time To Exhaustion (TTE), black bars are studies that used Time Trial (TT) as a performance metric. Credit: Is There a Need for Protein Ingestion During Exercise? 2014

At first glance it looks like carbs + protein is amazing for performance! But, there is more than meets the eye. Before we break it down, lets chat carbs quickly. The body is great at getting carbs from your gob into your muscles (suss out the last blog for more on this). On average about 60gms of carbs can be ingested and used per hour, so an optimal carb supplement should provide about 60gms of carbs per hour.

In the trials from the graph, they all used a similar format: a cyclist would ride a TTE (time to exhaustion) or TT test. Once with a carb drink (C) and then another time a few days later with carbs + protein (C+P) and the researchers would compare the times from the (C) to the (C+P).

With our knowledge of optimal carb supps lets break the trials down into 2 groups

  • “Optimal” Trials that used 60gms of carbs per hour in both (C) and (C+P). (trials from the above graph that had optimal carb supps were: Breen et al (2010), Osterberg et al (2008), Sanders et al (2009), Valentine et al (2008), Van Essen and Gibala (2006)
  • “Sub-optimal” Trials that used less than 60gms of carbs per hour in both (C) and (C+P). (trials which had sub-optimal carb supplementation were: Ivy-et al (2003), Lee et al (2003), Martinez-Lagunas et al (2010), Romano-Ely et al (2006), Saunders et al (2004), Saunders (2007)

When I replot the graph without the “sub-optimal” trials(<60gms of carbs per hour) the graph tells a different story

figure 2 cal
First graph with studies using sub-optimal carb delivery rates taken out. Credit Is There a Need for Protein Ingestion During Exercise* I couldn’t work out carbs per hr for Madsen (1996) and G Van Hall et al (1995) so we’ll give them the benefit of the doubt and leave them in.

Crazy how much this changes the picture! The effect size goes from quite large to either very small or non-existent. It’s pretty clear that when there are enough carbs delivered (>=60grams  per hour) adding protein doesn’t improve performance.

This makes sense when you think about it, carbs (and fats) are the fuel/s for endurance work. The body is great at burning them, great at storing them and great at delivering them from the gut and liver to the muscle to keep the body moving. So when the fuel tanks get low and you’re filling it up with fuel via a carb + protein drink the body will be mostly using the carbs, assuming there are enough carbs provided by the supplement. We see the theory work out in practice here: when a trial compares an optimal carb supp (C) to an optimal carb supp plus protein (C+P), there is little difference in performance.

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Image credit: IADE-Michoko via Pixabay

For something of more scientific merit than the homemade graph from above,  a systematic review on the topic concluded:

“it was also evident that when carbohydrate supplementation is delivered at or above 60 g·h−1, protein supplements provide no further ergogenic effect, regardless of the performance metric used”

Still, we saw that some of the “sub-optimal” trials had a performance improvement in the (C+P) group compared to the (C) group. The thing to remember is that in these “sub-optimal” trials the (C) and (C+P) were getting less than 60gms of carbs per hour, but the (C+P) group is getting extra calories from the protein and these extra calories might be helping fuel performance. Some of these trials delivered less total calories than an optimal carb supp would, this means that sub-optimal carbs intake + some protein may help performance more than just a sub-optimal carb supp. So you might get a small performance benefit from adding in protein if you’re short on carbs and there’s nothing else available.

Take home messages:

  • there isn’t much data on whether intra-session protein (alone) supplementation is good for performance, but, it is unlikely to help.
  • If you’re consuming less than 60gms of carbs per hour (ie trying to reduce caloric intake) adding protein may help you perform better
  • If you’re consuming the optimal level of equal to or more than 60gms of carbs per hour on a ride adding protein won’t help you go faster.

So intra-session protein for cycling performance?

The research says nah. Getting your 60gms of carbs in per hour is your best bet.

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Image credit: maxmann via Pixabay

Callum Baker

PhD Candidate | Accredited Exercise Physiologist | Clinical Teaching Fellow
The University of Sydney

 

A huge thanks goes to Callum for producing this article for Cyclist or Scientist. Great to have a PhD Candidate writing for the website in an area of expertise and I hope you gained a few handy pointers from the article. As for myself, I’m in Australia for another few weeks of training in the sunshine before heading over to Europe to get stuck into some racing with EvoPro. Until then, I’ll keep reading the research papers so you can spend more time on the bike.

Cheers,

Cyrus

Request a Topic

Want to know the results of research on a particular topic of interest? Any questions about a supplement, food or intervention you’ve heard is the next big thing? Leave a question or a topic suggestion in the comments and I’ll sift through the papers for you.

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