In this episode

When is pain a normal training response, and when is it a warning? In EP47, we speak with Nassos Koutsouradis, physiotherapist, endurance athlete and founder of Physioathens, about common running, cycling and triathlon injuries and returning to training without injuring the same area again.

We clarify what we actually know about popular recovery tools—ice, heat, stretching, foam rollers, massage guns, massage, recovery boots, acupuncture and electrotherapy—and where therapeutic exercise and strength fit in.

Detailed show notes

Pain and appropriate assessment

The discussion begins with a practical question: when pain or discomfort appears, should we first see a doctor or a physiotherapist?

Nassos explains each specialist’s scope and responsibilities, and the importance of cooperation between doctors, physiotherapists and other health professionals. He also stresses that steadily increasing pain should not be ignored simply to complete a workout.

Training load and equipment changes

Sudden volume increases, changes of surface, a different shoe drop, a new bike fit or changes in cycling position can substantially alter movement mechanics.

The guiding principle is gradual adaptation. This applies to beginners and experienced athletes alike, for whom even a small change may be repeated thousands of times within a session.

Bone oedema and stress fractures

Nassos describes how bone oedema can develop and how it differs from a stress fracture. This section highlights timely diagnosis, appropriate load reduction and a gradual return.

The conversation extends to nutrition and supplements, clearly stressing that assessment must be individualised by the appropriate professional.

Feeling better and actual rehabilitation

A central point is the distinction between something that makes us feel better and an intervention with a demonstrated effect on recovery.

Ice, massage and various recovery tools may offer relief or wellbeing. This does not necessarily mean they accelerate healing or create the adaptations needed to return to training.

Stretching and recovery tools

The discussion examines widely discussed recovery methods:

• stretching and mobility, • foam rolling, • massage guns, • compression boots, • electrotherapy, • dry needling and acupuncture.

The aim is not to reject every tool, but to understand what each can actually offer and when it serves as an adjunct.

Therapeutic exercise and strength training

Therapeutic exercise is presented as a cornerstone of rehabilitation. Strength training is not only about performance: it supports physical resilience, better load management and long-term consistency.

Particular emphasis is placed on the core and on systematically including strength training within an endurance athlete’s training cycle.

Returning to training

Complete inactivity is not always the best solution. Depending on the injury and professional guidance, training may be modified to preserve some fitness without loading the injured area.

The same applies after holidays or time away: the return should be progressive rather than abrupt.

The future of physiotherapy

The final section discusses:

• therapeutic exercise as a structured part of healthcare, • cooperation between specialties, • new technologies and less invasive interventions, • artificial intelligence as a supporting tool.

Nassos stresses that technology can help, but does not replace human assessment, a full history or understanding the patient’s daily life.

Key takeaways

  • Do not ignore pain that increases as you continue training.
  • Increase load gradually and introduce equipment changes progressively.
  • Do not equate temporary relief with recovery.
  • Therapeutic exercise and strength training are foundations, not optional extras.
  • Consult the appropriate specialist for diagnosis, nutrition, psychology and rehabilitation.