Sports
Pain, Injury, and Performance: Myths & Facts with André Ferraz
Physical therapist and ultramarathoner André Ferraz breaks down the difference between adaptive pain and real injury, debunking running biomechanics myths.
In an interview on Stemma Performance with Bruna Mahn, physical therapist André Ferraz debunks common myths about painkillers in sports, running biomechanics, and returning to training after injury. He explains how athletes can differentiate adaptive soreness from true tissue damage.
In endurance sports, experiencing pain is a virtually universal phenomenon. Whether in triathlon, marathon running, or extreme mountain racing, muscular discomfort is a constant companion for those pursuing athletic progression. However, the boundary between expected training soreness and clinical signs of an injury still causes widespread confusion among athletes of all levels. On Stemma Performance, host Bruna Mahn welcomed physical therapist and ultramarathon runner André Ferraz to discuss the primary myths surrounding pain, rehabilitation, and athletic performance.
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Delayed-onset muscle soreness vs. injury: identifying the signs
According to André Ferraz, delayed-onset muscle soreness (DOMS) is a direct physiological response to tissue adaptation under mechanical overload. It is a natural consequence of training that signals the body's need for recovery and remodeling. The problem arises when athletes fail to recognize the transition point between adaptive discomfort and an actual injury.
The key criterion for diagnosing an injury is the presence of functional impairment. Persistent pain lasting several consecutive days that prevents basic movement—such as lifting an arm or bearing weight on a foot—accompanied by loss of strength, local heat, or redness indicates active inflammation or structural tissue damage. In these scenarios, pushing through prescribed workouts without professional intervention will only worsen the condition.
The dangers of masking symptoms with medication
One of the most harmful habits highlighted during the conversation is the routine use of painkillers and nonsteroidal anti-inflammatory drugs (NSAIDs) to endure long training sessions or races. When an athlete medicates mechanical or muscular pain, they directly interfere with central nervous system signaling and eliminate the adaptive physiological benefits stimulated by exercise.
Beyond impairing conditioning gains, using anti-inflammatories during prolonged exertion poses a severe risk of renal overload. In multi-hour events where physiological stress and dehydration already strain the kidneys, repeatedly administering these medications drastically increases the risk of acute medical complications, turning athletic perseverance into health negligence.
Effective strength training and respecting periodization
When it comes to injury prevention, Ferraz emphasizes that traditional machine-based gym workouts offer limited functional transfer for runners and triathletes. Machines like the leg press do not shield joints from running impacts; the sole notable exception is the leg extension machine, as it is an open kinetic chain exercise capable of precisely isolating the quadriceps.
To build true muscular resilience for endurance, strength training should prioritize free weights, progressive overload, and unilateral movements such as lunges and split squats. Concurrently, physical therapy works to optimize motor control and accessory muscle function. Ferraz also points out that a major share of injuries stems from ignoring prescribed training zones, particularly when athletes execute recovery or easy runs at intensities far higher than designated by their coaches.
The myth of the perfect running form and return to sport
Another central topic was the obsessive pursuit of correcting running gait and biomechanics. Ferraz highlights that there is no solid scientific evidence directly linking isolated anatomical variations—such as dynamic knee valgus—to guaranteed injury. The body develops individualized movement patterns over years of training, and mechanical efficiency evolves naturally with cumulative mileage and task repetition.
Ultimately, rehabilitating an injury addresses both biological tissue regeneration and the psychosomatic dimension of pain. Even after bones and tendons have structurally healed, the central nervous system can retain a traumatic movement memory. Full recovery requires gradual, progressive load exposure (the envelope of function), re-educating the brain and restoring the athlete's confidence to return safely to peak performance.
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