A Scoping Review of Physiological and Behavioural Pain Responses of Ultramarathon Runners

Abstract

Pain during ultramarathon races is almost inevitable. Effective pain responses are associated with enhanced race performance. This scoping review synthesises the existing literature on physiological and behavioural pain responses during ultramarathon races and explores the association of these responses with performance. Following the PRISMA Extension for Scoping Reviews (PRISMA-ScR), we included 31 studies. We organised the extracted data into five overarching categories: neurophysiological mechanisms, running mechanics, medication use, physical therapies, and performance outcomes. Our results show that some ultramarathon runners exhibit exercise-induced analgesia, whereas others exhibit inflammation-driven pain sensitisation. Changes in running mechanics during races may be a response to present or anticipated pain. In addition, many ultramarathon runners take pain medication during the race, mainly to prevent or reduce pain. During ultramarathon races, massage interventions may relieve pain. Finally, ultramarathon runners’ performance may decline in the presence of pain. Among ultramarathon runners, a variety of pain responses are associated with race performance. Because effective pain responses may lead to better performance outcomes, future research should investigate the causal mechanisms linking pain experiences, pain responses, and race performance.

The authors' abstract, as published at the source. Sports, 2026 · DOI ↗