481: Pain Is Not a Fixed Trait: What the Berlin Marathon Teaches Us About Pain and the Brain

What do you think would happen if you completely ruptured your Achilles tendon with two kilometers left in a marathon? Most of us would probably assume the race was over. But Tigst Assefa’s 2026 Berlin Marathon story forces us to ask a much more interesting question: how could someone experience a significant injury and still keep running at an incredibly fast pace? Assefa developed pain around 31K, eventually completely ruptured her Achilles around 40K, and still finished the race, won, and set a course record. That doesn’t mean she somehow didn’t have an injury or that pain is “all in her head.” It gives us a fascinating look at how the brain processes pain and how much context can influence what we actually feel. In this episode, Angie and Kevin break down the idea that pain is an output created by the brain based on much more than tissue damage alone. Your brain is constantly taking in information about what is happening in your body, along with your stress level, sleep, emotions, attention, past experiences, expectations, social environment, and how important the current situation is to you. They talk through examples ranging from phantom limb pain and the famous construction-worker nail story to elite athletes, childbirth, war injuries, and their own experiences with running and pain. The bigger takeaway is that pain isn't simply an on/off switch. It's more like a volume dial that can move up or down depending on the context. And this is where the conversation gets really practical for everyday runners. You can learn to change some of the inputs that influence your pain experience. Better sleep, reducing chronic stress, having a meaningful goal, shifting your attention outward, social connection, gentle movement, and slow breathing can all help turn the volume down. But Angie and Kevin also emphasize an important warning: becoming really good at ignoring pain isn't the goal. Pain is still a protective signal, and turning that signal down too far can allow you to continue running through an injury that needs attention. The goal isn't to become someone who never feels pain. It's to develop more nuance around what you're feeling, understand the context, and learn when to listen, when to adjust, and when you can safely keep going. 00:00 – Berlin Marathon Shock 01:44 – Achilles Rupture Details 03:34 – Pain Comes From Brain 04:34 – Phantom Pain Stories 05:54 – Pain Inputs Explained 08:48 – Turning Pain Down 09:43 – Achilles Anatomy Q&A 12:29 – Descending Modulation 16:23 – Stress and Pain Effects 20:40 – Elite Athletes and Pain 23:51 – Research on Pain Tolerance 27:01 – Training Builds Nuance 29:42 – Trauma And Ultra Running 31:54 – Stress Kills Pain Edge 33:43 – War And Survival Analgesia 39:03 – Childbirth Expectations Shift 41:28 – Everyday Pain Amplifiers 47:59 – How Pain Spirals In Races 48:49 – Tools To Turn Pain Down 54:30 – When Tuning Out Backfires Gain access to my new secret podcast, Unbreakable: The Runner's Guide To Injury-Proofing Your Body After 40. Click here: https://www.realliferunners.com/secret Join the Team! -->  https://www.realliferunners.com/team  Thanks for Listening!! Be sure to hit FOLLOW on Apple Podcasts, Spotify, or your favorite podcast player  Leave a review on Apple Podcasts. Your ratings and reviews really help and we read each one! Come find us on Instagram and say hi!   Don't forget: The information on this website is not intended to treat or diagnose any medical condition or to provide medical advice. It is intended for general education in the areas of health and wellness. All information contained in this site is intended to be educational in nature. Nothing should be considered medical advice for your specific situation.