Rate Your Client’s Pain Tolerance With This Easy Assessment

The ability to tolerate discomfort (or pain, as some say) is for the most part, a necessity in order to perform to one’s athletic potential. As such, Rate of Perceived Exertion (RPE) is a commonly used metric to prescribe intensity by. In the 1960’s a Swedish psychologist, Gunnar Borg came up with RPE scales. The most common was the Borg CR10 scale which was based on a 0-10 scale, with 10 being the most intense. This is the scale most commonly used by coaches, as well as hospitals when trying to determine how much pain or discomfort a patient has.

VARIED INTERPRETATIONS OF INTENSITY

While RPE can be an incredibly effective ‘tool’ to both prescribe and assess intensity, it has an inherent flaw.

People interpret pain/discomfort differently

Typically when prescribing and assessing RPE, the assumption is that a level 10 represents the highest possible level of intensity. If you’ve ever watched cross-country ski racers cross the finish line, they almost always collapse on the ground and lay there for a while with their chests heaving up and down… this would be representative of an RPE of 10. Conversely, walking on a treadmill at 2.0 would likely qualify as somewhere around an RPE of 0 or 1.

As a both a personal trainer and endurance sports coach of over 20 years, if there is one thing that I’ve learned, it is that if I were to ask 20 clients what a 8/10 RPE feels like, I would likely get 20 different answers – hence the issue with using RPE as an intensity benchmark.

Therefore as a coach, it is critical to be able interpret a client’s RPE.

THE ASSESSMENT

We train our coaches to use a UESCA assessment termed the, Perceived Intensity Assessment (PIA). This is an important assessment because it gives you an indication of what your client’s interpretation of “intense” is. While you will never be able to say with 100 percent certainty if a client’s RPE equates to the true corresponding physiological level of intensity, the PIA allows you to have a better idea of how physiologically accurate a client’s RPE number is.

The PIA uses a wall sit to assess perceived intensity. Wall sits are performed by having your clients “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 clients of the real reason for this assessment. Rather inform them that you are assessing their quadriceps strength. 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. However, 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 0 to 10 for intensity (10 being the most intense), they should hold it until a level 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 notice if they have to catch their breath or 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 0‒10 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.

The reason for using this exercise for the assessment is twofold.

  1. The wall sit is a safe exercise as it is isometric and does not put stress on the lower back.
  2. Due to the isolation of muscular activity (quadriceps), the muscles fatigue quickly, and therefore it is a relatively quick assessment. Note, 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.

PURPOSE OF THE PIA

The PIA is as much a mental assessment as it is a physical one. You are using a physical exercise to perform a mental assessment of your clients regarding their tolerance of exertion. In this case, the mental assessment is based on pain tolerance. Typically, former or current athletes rate quite high on this test as they are accustomed to exercising at high intensity 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.

THINGS TO CONSIDER

  • An individual’s perception to intensity may change throughout training. Therefore, PIA reassessments are recommended
  • Pain tolerance and pain threshold are two different things. Most people have similar pain thresholds, however the ability of individuals to tolerate pain/discomfort varies and this what the PIA is looking to ascertain.

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