Examining the effectiveness of reflective practice, self-regulatory and cognitive strategies to enhance sport-specific risk and pain management during ultra-endurance performance.

Pain is an accepted and normalised aspect of participation in ultra-endurance sports, influenced by biological, psychological, and social factors. Despite their proven achievements and growing participation rates, female ultra-athletes remain an understudied population. This thesis addresses the research gap by examining female ultra-athletes' pain experiences and coping strategies through a biopsychosocial lens. Using a multi-phase mixed methods design, three complementary studies investigate how female ultra-athletes perceive, evaluate and cope with pain across different sports, capturing these experiences through retrospective, longitudinal and real-time temporal dimensions to reflect the multidimensional and subjective nature of pain. Study 1 used Interpretative Phenomenological Analysis to explore the retrospective lived pain experiences of 13 female ultra-athletes. The ability to push through pain was influenced by personal backgrounds (e.g., trauma, life situation) and the inextricable link between psychological wellbeing and physical health, where athletes' drive to maintain mental equilibrium through training often created tension with physiological recovery needs. Study 2 longitudinally examined pain, mood, pain coping, and recovery of three professional ultra-triathletes over 64 weeks, revealing how professional identity shaped pain interpretation and management strategies. Pain experiences fluctuated dramatically based on numerous biopsychosocial factors, with major injury events creating new perceptual benchmarks that "reset" athletes' pain scales. The COVID-19 lockdown revealed how pain tolerance was intrinsically tied to professional purpose rather than being an inherent trait, with athletes conceptualising pain as actively chosen when serving meaningful competitive goals. Study 3 analysed real-time pain experiences of five ultra-endurance athletes during their chosen ultra-sports events. Think-aloud verbalisations illuminated a variety of sport-specific pain experiences and coping strategies (e.g., chunking distance during running and counting pedal cadence up steep mountain passes), as well as the biopsychosocial (gastrointestinal issues, anxiety, mood, mom guilt, and support crew) and environmental factors (weather, terrain, different country) that influenced their pain perceptions and coping strategies. The integrated findings established how self-reflective experiential learning had developed a tacit bodily awareness for how to interpret their race and injury-related pain. The years of accumulated ultra-endurance pain experience had facilitated athletes’ planning with future expected pain experiences through development of self-regulatory coping strategies. Comprehensive support networks proved to be invaluable to assist with both immediate pain management and long-term athlete wellbeing. Practical implications include the need for interdisciplinary support networks, especially for athletes whose drive to push through pain is linked to maintaining mental wellbeing, potentially leading to overtraining and injury. Recommendations include structured pain education, development of personalised self-regulatory coping strategies, and facilitation of social support to maintain balanced physical and psychological wellbeing for female ultra-endurance athletes.