The real reason strength training helps with pain and injury rehabilitation

If you have knee pain, back pain, or creaky shoulders, you’re likely to be advised to strengthen your muscles. After all, exercise is the most effective treatment for various problems with muscles and joints.

But a group of medical clinicians and researchers say this logic is flawed. Written for the British Journal of Sports Medicine. There’s a lot of evidence that exercise does indeed help reduce pain, but it’s not clear whether increased muscle strength is the main reason. Rather, exercise may have other rehabilitation effects that should be emphasized more.

For example, knee osteoarthritis is one of the most common causes of pain and disability in adults, and targeted leg strengthening exercises are considered the primary treatment for knee osteoarthritis. That’s natural. Strengthening your leg muscles should take some of the stress off your knee joints.

a Recent meta-analysesA study combining the results of 12 studies found that exercise actually reduces pain and improves physical function in people with knee osteoarthritis. However, its effectiveness did not depend on how strong the patient became. In fact, only 2% of the observed improvement could be explained by increased strength.

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“That’s not to say there’s nothing, but it doesn’t seem to be the main mechanism of improvement,” says Jared Powell, a physiotherapist at Australia’s Bond University and lead author of the new study.

The same goes for a variety of other conditions, including lower back pain, rotator cuff problems in the shoulders, and knee and calf tendon pain. In both cases, research has shown that strength training is effective, but the benefits are not proportional to the increase in muscle strength.

Powell and his colleagues suggest several other reasons why exercise may help with this type of musculoskeletal pain. For example, physical activity is known to reduce inflammation throughout the body and may alleviate symptoms of inflammatory conditions such as knee osteoarthritis.

A well-planned, gradual exercise routine may also help you lose fear of movement (what clinicians call kinesiophobia), which can occur after long-term pain or injury. Continuing to move the affected joint or limb can also reduce the devastating pain, where minor discomfort inevitably cascades into more severe pain.

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The latter explanation is more difficult to measure and quantify, but it reflects a growing belief among doctors and scientists that the experience of pain depends not only on the signals the body generates, but also on how those signals are interpreted by the brain. And they suggest that the exact details of the rehabilitation program you follow may not be as important as previously thought.

“Perhaps just as important as the exercise itself is the context in which it is performed,” Powell says. “Clinicians who build trust, validate patients’ experiences, and help patients reengage with activities they value are probably doing more than any particular set-and-rep approach.”

This does not mean that physical fitness is not important at all. Powell’s physical therapy focuses on shoulder pain, and strength training is an important part of his treatment arsenal. “There’s something about gradually lifting heavier weights that powerfully shifts a person’s self-concept from ‘fragile’ to ‘sturdy,'” he says. “I would never deny that.”

However, there is a definite benefit to recognizing that muscle strength is not the only goal of a rehabilitation program. That means your pain may improve, even if your strength doesn’t seem to be improving as quickly as you hoped. It also gives you the flexibility to tailor your exercise program to your interests and goals.

“Changes in muscle strength may contribute to pain outcomes in some people under some conditions,” Powell says. “But as one element in a broader recipe.”

alex hutchinson He is the author of The Explorer’s Gene: Why We Seek Big Challenges, New Flavors, and the Blank Spots on the Map.