This week I was reminded of just how resilient we are as humans.

I had a new patient, who happens to be a nurse, who came in because of back pain that limited her from doing certain activities. Those activities were pretty important to her…namely, being able to care for her grandchildren. She was worried about being able to lift and carry her 6-month old grandson or her 3 year-old granddaughter.

But her pain wasn’t always there, so she had been putting off doing anything about it for quite some time…like several years.

“I have a high pain tolerance,” she said proudly while I was taking her history.

“That’s 2-strikes against you,” I replied, using a baseball phraseology. “You see, if you keep putting up with your pain, you just keep getting to experience that level of pain. Worse still, in many cases, people have more frequent and more intense back pain that is more limiting as they ignore it for longer. If you have 2-strikes on you when playing baseball, it only takes one more and you’re out.”

She was a little taken back by that.

Do you think that having a high pain tolerance as something that you should be proud of?

If you’re like most people, you do. But is that a good thing for you?

But first let me clarify the difference between pain tolerance and pain threshold.

We often use a numeric scale to “rate” the pain. It is from 0-10, where 0 is no pain at all, and 10 is the most excruciating pain you can imagine (or have experienced in the past). I like to break this down further in my mind…and I’m usually able to deduce your pain rating before you tell me the number.

Here is my breakdown (by the way, this is purely anecdotal, so I have NOT researched this scientifically, but it is pretty accurate in practice):

0=No pain at all

1-2= You have to think about the pain to notice it. This level you will ignore when you are doing pretty much any activity.

3-4=The pain is there and noticeable without you thinking about it. It does not prevent you from doing an activity, but you are aware of the pain/discomfort.

5-6=The pain is now enough to make you question if you should continue your activity.

7-8=The pain prevents you from activity or forces you to stop during the activity.

9-10=Unable to do almost anything. Contemplating emergency room visit, or actually on your way to the ER.

Your pain tolerance is the amount of pain that you are willing and able to put up with before you do something about it. This is variable between people and even variable for a single person depending on the type of pain.

For instance, you might be willing to put up with pain in your wrist if you are training for a marathon. In fact, the wrist pain could be debilitating (6-7/10) when eating, writing, or even washing your hands. But if you wanted to complete the marathon that you have worked so long and hard to do, you might be willing to put up with the pain in the wrist.

However, a 7/10 pain in your foot would make you think twice about continuing to push through that pain to continue running. The wrist pain probably won’t prevent you from running your marathon, but your foot pain just might. Same pain level, but different decision process for you. For this example I am assuming that the foot pain is NOT caused by something bad, like a stress fracture. Let’s assume it’s just a nasty blister.

Now it is up to your willingness to put up with your pain…or not. That is your pain tolerance.

Your pain threshold is the level of discomfort that you can put up with before you consider it to be painful. A threshold is defined the point at which a physiological or psychological effect begins to be produced.

Notice that can be either a physiological or psychological effect. I’d argue that pain is BOTH.

Now, if you have been tired and run down, not sleeping well, and under stress at work, a little discomfort can be quickly perceived as being painful. Of course, if you just won a million dollars in the lottery, chances are good the same discomfort would not be painful at all. So your psychological outlook, bad or good, can alter your pain threshold.

So, now back to my patient…you remember, the nurse-grandmother, who has been patiently sitting by and waiting for me to explain all of this in my blog.

The back pain was only a 2/10 as she was talking with me. But she had unpredictable, intermittent sharp pains to a 7/10 that would limit her very quickly. Her concern was that she would experience a sharp pain when trying to lift her grandson, possible prompting her to drop him in response to the pain.

That’s a legitimate fear for her. Especially since she had no way to predict when she would have the pain episodes.

Have you ever had one of those pains? You know the one, it hurts like mad when you move, blinding pain instantly there, but then gone as fast as it came? And then it repeats, but at a different time and with a different movement. You have no way of predicting when it will occur. That is enough to make you apprehensive about moving and doing…maybe enough to make you avoid activity for fear of getting that blinding level of pain again.

Now I’m not suggesting that life must be pain-free to be good. Quite the contrary. Pain is a normal part of living. Let’s face it, unless you feel some pain and soreness after a workout, you don’t feel like you accomplished anything. That being said, I’m also not advocating for blindly pushing through pain.

And that’s where the difference lies. What do you think is an acceptable amount of pain?

My patient’s tolerance of her back pain was completely acceptable to her, until it made her worry about lifting her grandson. Then it crossed the threshold. It was no longer acceptable…and she had to do something about it.

Try to keep this story in mind when you are training for your next event…or just working out to keep yourself active.

One of my favorite patients (and you’ll know who you are as you read this ) told me that he has a conversation with his body every time he is training for an Ironman. Inevitably, something hurts while training for the race. Think about it, you swim for 2.4-miles, bike for 112-miles, then finish with a marathon run of 26.2-miles. Something is bound to hurt.

Maybe everything is bound to hurt with that race…but this patient listens to his body, and is able to talk to himself about whether that pain is limiting or if it is just a nuisance. In other words, he is always assessing if the discomfort has crossed the threshold to being a real problem that limits his ability to continue.

So, is putting up with your pain, a.k.a. having a high pain tolerance, a good thing, or is it 2-strikes against you? It can be difficult at times to tell. After all, pain does not always mean damage.

Only you can decide what you consider to be an acceptable level of pain. And your “acceptable level” can change! But if the pain, no matter the level, is forcing you to change your activity, I would encourage you to get that examined further by your medical provider. It might help you avoid getting the third strike and being out of the game for a while.