How to Assess Your Client’s Pain Tolerance

Coaches often use ‘Rate of Perceived Exertion (RPE)’ as a way to both prescribe and get feedback from clients’ workouts. Perceived exertion relates to how hard an individual perceives an exercise or training to be.

In more simple terms, you are assessing what an individual’s pain tolerance is. Most coaches use a 1-10 scale to assess RPE (1 – low exertion, 10 – high exertion). The RPE scale is both a great way to prescribe and get feedback from clients, with one caveat… the RPE scale is subjective and individual’s pain tolerances vary. For example, one person’s RPE at a 7 will likely be very different from another person’s 7.

PAIN TOLERANCE vs. PAIN THRESHOLD

In respect to RPE, it’s important to note that most people have very similar pain thresholds. This means that most people experience pain or discomfort at the same levels of intensity. What differs is the pain tolerances of individuals.

In other words, some people are better at dealing with pain or discomfort than others. From an athletic point of view, having a high pain tolerance is usually considered a good thing, as an athlete can ‘push through’ pain and discomfort when others would tend to slow down or stop. However, it must be noted that pain is the body’s way of protecting itself. So while it is sometimes a good thing to push through discomfort, it is rarely a good thing to push through pain as this can lead to injury.

SO WHAT’S THE ISSUE WITH RPE?

Screen Shot 2017-04-08 at 3.05.58 PMSince individuals’ pain tolerances vary, it can make the RPE assessment hard to assess and get real value out of. Here’s an example… you have two clients who you tell to run a mile as fast as they can and then tell you what they thought their RPE averaged during the run (RPE scale was explained to the runners). The first runner is totally spent after the mile and is so out of breath they can’t speak for a few minutes or stand up after completing the run. When asked what their average RPE was on a 1-10 scale, they say 9. The second runner crosses the finish line and is barely out of breath and can talk easily. They rate their run as a 9 as well. See the issue?

Based on the RPE scale, the first runner is likely correct in their assessment of a 9. However, as is defined by RPE scale, the second runner is likely closer to a 4 or 5. So why the discrepancy? The most likely answer is that runner #1 has a relatively high pain tolerance and runner #2 does not.

Here is the real issue with RPE in regard to coaching clients. Unlike this example, you will likely not physically be present at each and every one of your clients’ workouts to witness their exertion in relation to their RPE feedback. Therefore you will be relying on their feedback. In the above scenario, based on RPE, while both of the runners ran at the same exertion level, their intensity at which they ran was quite different. As a coach, it is imperative to know and understand how a client correlates intensity to RPE.

THE SOLUTION!

Alyssa Wall SitOur company, United Endurance Sports Coaching Academy (UESCA) has developed an assessment to determine how a client relates their intensity to RPE. This assessment is instrumental in determining if RPE should be used as a programming guideline and if so, what RPE level(s) to prescribe to clients.

The Perceived Intensity Assessment (PIA) uses the wall sit exercise to assess intensity. The wall sit was chosen for several reasons:

  1. It primarily isolates one muscle group (quadriceps) and therefore the chance for injury is quite low. While this is a safe exercise, your clients will likely experience muscular soreness in their quadriceps in the following days. This is especially the case if a client is new to resistance training.
  2. When done properly, the discomfort level is quite high
  3. The test is relatively short due to the intensity

THE PIA ASSESSMENT

Have your client “sit” with their back against a wall with their hips and knees at 90-degree angles. Instruct them to keep all their weight on their heels and to lift up the balls of their feet. By performing this modification, most all of the muscular stress is placed on the quadriceps. DO NOT inform them of the real reason for this assessment. Rather, inform them that you are assessing their quadriceps strength. If you inform them of the real reason for the assessment, they may try to hold the position for longer than they normally would. You don’t want this. You want to see how they respond to an exercise, not an assessment.

After instructing them on the correct form, tell them to hold it as long as they can, otherwise known as, holding until failure. Inform them that they will feel their quadriceps start to burn but that they should try to push through the initial burning sensation and hold the wall sit for as long as possible. Since this assessment is correlated with the RPE scale, instruct clients that on a scale from 1 to 10 for intensity (10 being the most intense), they should try to hold it until a level 9 or 10.

While they are performing the assessment you will want to assess the following areas:

  • Visible facial signs of fatigue and discomfort (e.g., grimacing, focused eyes, clenched teeth)
  • Visible body signs of fatigue and discomfort (e.g., legs shaking, toes wanting to lower, body starting to lower on the wall)
  • After the exercise ends, do they collapse on the floor or do they casually stand up and ask what is next

For this assessment, you might find it helpful to assign perceived intensity levels associated with the client’s body response. For example, if a client collapses on the ground when his or her legs give out, this could represent a 9 or 10 (out of a 1‒10 scale). However, if a client is talking throughout the test and shows no strain when stopping the wall sit, this might be representative of a 2 or 3.

You are using a physical exercise to perform a mental assessment of your clients regarding their pain tolerance.

Typically, current and former athletes rate quite high on this test as they are accustomed to exercising at high-intensity levels and have a relatively high pain tolerance. After performing the assessment, you will have a fairly good idea of where your client’s intensity and pain tolerance lies. The purpose of this test is not to see how long your client can hold a wall sit for, but rather the physical characteristics of your client throughout the assessment, which in turn, you will use to decipher the individual’s level of perceived exertion. This will help you to understand how your client interprets intensity and therefore will help you to direct your client. 

Ideally, this assessment should be done at the onset of working with a client as well as throughout the training process to assess progression.


Rick Prince is the founder of United Endurance Sports Coaching Academy (UESCA), a science/evidence-based endurance sports coaching education company that certifies running and triathlon coaches.

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Rick Prince

Rick Prince

Founder/Director of United Endurance Sports Coaching Academy (UESCA).

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