Trust, Empathy and Pain Training Flexibility

A productive coaching relationship built on mutual trust and empathy improves flexibility progress.
Ashleigh Flanagan
August 3, 2023

I have written plenty about pain and flexibility training.

In review:

Pain is a normal part of flexibility training. Stretching hurts because you are moving further into range than usual. Pain on novel inputs is part of how our bodies reduce the risk of harm. A big part of increasing flexibility is learning to accept pain and becoming less sensitive to stretching stimuli. Pain tolerance involves learning from experience that you can cope, and despite pain, you are safe. Pain sensitivity reduces as your body becomes more familiar with stretching, so less likely to interpret the inputs as potentially harmful. (Learn about pain tolerance and pain sensitivity here)

A recent study by Ellingsen et al. (2023) (read the study here) and reviewed by Medscape (read the article here) considered the role of therapeutic interactions on pain, focusing on trust and empathy.

The study exposed subjects to noxious stimuli and asked them to rate their pain while a fMRI monitored their brain activity. Some people were left alone, while others had a doctor in the room. Unsurprisingly, those on their own rated their pain significantly higher than those with a doctor present.

Interestingly, the study had some subjects meet with their doctor before the scan. While they rated pain the same as those who didn't meet the doctor first (but had a doctor in the room), they felt that the doctor could better understand their pain experience after a personal interaction and rated higher trust, indicating empathy.

How does this relate to flexibility training?

It's a bit of a stretch…BUT

Like in the study, people report experiencing more pain when they stretch on their own and seem to perform better in groups or with a coach. This is likely due to accountability and a critical eye, as well as reduced pain sensitivity and increased pain tolerance.

Students progress further and faster if they trust in their work with their flexibility coach. Placebo is the neurobiological phenomenon that describes positive outcomes that result from a person's belief that an intervention will work. I have previously discussed how important expectation is to flexibility progress. Read the blog here.

The study by Ellingsen et al. (2023) infers trust in your practitioner increases pain tolerance. Those in the study who spoke with their doctor before the scan showed increased  prefrontal cortex (PFC) activity. This brain area is key to emotional regulation and positive action in threatening situations. The Sympathetic Nervous System (SNS) initiates in response to potential threat and prepares the body to act in self-preservation. Part of this response increases pain sensitivity, so you are more alert to possible dangers. The PFC down-regulates the SNS response by providing rational threat evaluation. For example, when you stretch and feel like your leg will snap off, the PFC recognises this can't happen, resulting in reduced epinephrine and norepinephrine secretion. In the study by  Ellingsen et al. (2023), the greater the reported trust in the practitioner, the more active the PFC. In a similar way, your trusted coach reassuring you that you are fine may reduce your pain sensitivity.

Despite what is commonly believed, people aren't born empathetic. Empathy is learnt. It's the skill of interpreting the experience of another and reflecting this back to the person to establish a meaningful connection. Empathy is critical to productive coaching relationships. Coaches don't need to experience everything their students do, and shouldn't act out of pity or sympathy. However, a good coach will take time to understand the perspective of their students and relate this to them. Watch this short video by Brene Brown about the difference between sympathy and empathy.

A productive coaching relationship built on mutual trust, respect and empathy, improves flexibility progress by reducing pain sensitivity and increasing pain tolerance. Training in an environment that supports success, with like-minded, encouraging and supportive peers, is likely to amplify this effect. Coaches should be mindful of how interactions impact the effectiveness of training.

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