Rafael Nadal has lived with Müller-Weiss disease since 2005. It has been 17 years since a match against a degenerative deformity in his left foot that has not made him lose his smile and his desire to play, although he sometimes admits, as he did on 12 May when he was left out of the Italian Open that the happiness he gets from training and playing begins to match or lose the game to the pain with which he does it. That perpetual match between happiness and pain is a game of the head rather than the racket. How do you play it?
According to Dolors Soler, researcher and specialist in rehabilitation psychology and neuropathic pain at the Institut Guttmann, "a good part of Nadal's management of discomfort could be explained because they show a high 'resilience to pain', something that is receiving recognition every time by researchers and doctors to understand and treat chronic pain," Soler told La Vanguardia.
"Some athletes are able to continuously and repeatedly overcome pain to maintain their competitive level, because they are prepared for it. Sometimes they are rewarded with success, and sometimes, despite their desire to overcome and contribute, their body succumbs to the consequences. Perhaps the most successful athletes are those who best understand the relationship between pain and performance: they are prepared to overcome pain, but they make wise and informed decisions about when it is worth trying", details Soler.
Iolanda López-Iglesias, an expert professor in the psychopedagogy of talent and high abilities at the International University of La Rioja, who uses Nadal as a model of good management of talent, frustration, effort and balance in her classes, believes that training mental is what builds the resilience of the tennis player.
“Nadal has a privileged mind that works, prepares and trains. He strives to lead a balanced life in his projects and his private life, and he has a lot of self-control, ”López-Iglesias declares to this medium. "In addition, he knows himself very well and is open to change and transformation when circumstances demand it or the team of people he trusts by his side suggests it," he adds.
For Soler, moreover, a resilient individual is capable of experiencing positive emotions and maintaining higher performance.
Researchers from the University of Heidelberg, Linette Liqi Tan and Rohini Kuner, published a scientific review a few months ago in Nature Neurosciences where they admitted that one of the great challenges of biology and medicine is to understand how a perception of pain is created, specifically and variable in each person. Understanding this will allow us to help more people with a more personalized approach.
The researchers' review breaks down almost 170 scientific works on this subject, and makes it clear that the painful experience is highly modulated by cognitive, motivational and emotional factors, and involves the most developed and youngest part of the human brain: the neocortex, " that continually drives a plethora of brain functions such as decision-making, memory, and emotion.”
According to Soler, without a doubt it can affect cognitively, with good brain health, and according to the review and the previous works of scientists, too, but the mechanism is not as easy as just wishing it, although it influences, or is not yet shelled with enough detail.
Soler summarizes four main stages in grief to understand how and where it could be affected to better cope with it. These stages are: the propagation of the damage signal, such as an electrical current, from the nociceptors or receptors of the tissue where it occurs; the journey of that signal down the spinal cord to the brain; the activation in the brain of several areas that are the ones that will build our perception of pain; and, finally, and what Soler finds most fascinating, the modulation of signals between neural circuits, which condition that perception.
“The modulation has two directions: from bottom to top, from the damaged area to the brain, and from top to bottom, from the brain to the damaged area”, states the researcher. "Pain can be regulated with proven strategies. With exercise, for example, you burn off and inhibit the stress response, and you tolerate pain better. Diverting attention to something else, and taking attention away from pain, also becomes more tolerable." , exemplifies the researcher, an expert in modulating pain with electrical stimulation and virtual reality in amputated patients and patients with spinal cord injuries.
The descending pain pathways that Soler refers to are intimately linked to parts of the brain with various functions, including the amygdala, “which is a station that starts up to generate a cortical alert and activate stress. What we know as periaductal gray matter also plays a very important role, and it is rich in opioids, but it has 'on' neurons that are activated by pain stimuli, intensifying it so that we act, and 'off' neurons that reduce pain perception. pain releasing opioids”, explains Soler.
“There are also serotonergic neurons that regulate and inhibit pain and explain placebo analgesia, which occurs due to the expectation that what you are taking will benefit you due to a cognitive perception that causes you to generate endorphins, including dopamine. , also linked to descending pathways and to the well-being reward circuit”, adds the researcher.
In fact, as the Heidelberg researchers point out, placebo, along with mindfulness, are forms of analgesia without drugs that are beginning to be used and activate the same relaxation pathways as opiates.
Guttmann's doctor explains how some patients, when injured or have suffered an accident, do not feel pain to be able to act and ask for help, and the pain is postponed until later. “Our brain is programmed to guarantee our survival, and it has its priorities. Pain is an alarm system that must work very well, but our brain is capable of prioritising. Someone who has been injured but who has to ask for help to save himself, as was the case of a patient who was accidentally pierced by a hunter's bullet while riding a bicycle, was able to ask for help and do everything necessary to they could treat him,” says Soler. “Upon waking up, the patient was in excruciating pain, but when the bullet went through him, his brain prioritized doing what was necessary to survive,” she says.
According to the researcher, there is an inherent and natural decision-making process in a pain condition that will determine whether to continue to persist despite the presence of pain: "when an anticipated reward or reinforcement is perceived as more important for survival than the reduction pain, the body will continue its search," he says.
One of the things that Nadal explains in the Telefonica video is dedication to the game and a tension due to the attention paid to the game, point by point, with respect to the opponent and the game that can change in the most unexpected way, so that it is better not to trust and release that tension. That concentration and self-control is what is surely saving the Manacorense tennis player a lot of discomfort and turning him into an example of resilience.
Going out to give everything with determination, tenacity and training make the motivation to continue playing for so many years win his personal match against the condition that drags his left foot. Although sometimes he falters, and in the last statements he admits that, perhaps, this is his last Roland Garros. Or not.
