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This week, we’re digging into one of the most common phrases in rehab:
“You can’t go wrong getting strong.”
It’s a powerful message — and generally a good one. Strength builds resilience, supports longevity, and gives people a sense of control in their recovery.
But when this becomes the only approach to resolving pain, we can run into problems. Many patients — and even some clinicians — believe that pain exists because of weakness. And that recovery will require hard work, heavy lifting, and a level of fitness they’re not ready for.
That mindset can lead to self-blame, avoidance, and in some, belief that their body is broken.
Let’s explore the nuance — because while strength is valuable, it’s not always what gets people out of pain.
Strength matters.
It supports health span, may reduce injury risk, and helps people feel more capable in their bodies. In The Lancet (
Leong et al., 2015), grip strength was shown to be a better predictor of mortality than blood pressure — a striking insight into how muscular strength reflects overall health.
In sport rehab, hip adductor strength has been linked to increased
groin injury risk in some athletic populations. However, the relationship between strength and injury
is far from clear-cut.
For instance,
studies have shown that runners with and without anterior knee pain often present with similar strength profiles, suggesting that pain isn’t always a simple output of weakness. And if you use strength training as a
treatment, symptoms can improve but strength remains
unchanged.
So long story short:
Strength training can help with pain—even if your strength doesn’t actually change.
In
Littlewood et al., 2016, patients with shoulder pain improved significantly using low-dose, self-managed movement —
without measurable strength gains.
In the QUADX-1 trial (
Husted et al., 2022), patients with severe knee OA — all eligible for knee replacement — did just one home-based knee extension exercise 2–6 times/week for 12 weeks.
✅ Strength improved slightly.
✅ Pain and function improved.
✅ 67.5% postponed surgery.
Pain got better—and strength wasn’t the driver and it wasn’t about heavy lifting.
Bottom Line:When we’re in pain, strength isn’t lost—it’s temporarily suppressed, sometimes hard to access.
Think of it like
DOMS: the strength is there, but the nervous system is holding back.
It’s not deconditioning—it’s a healthy protective response doing its job. And when pain settles, that strength often returns—quickly, quietly, and often without any heavy lifting at all.
“You can’t go wrong getting strong” is a powerful message — simple, actionable, and mostly true.
But in clinic, it can become a kind of doctrine:
- “Let’s get you stronger and the pain will go away."
Patients often arrive already believing it. Ask what they need to get better, and you’ll hear:
- “My core is weak, probably more core work.”
- “My shoulder isn’t strong enough.”
- “I need to strengthen my legs.”
These beliefs aren’t always neutral. They often carry
self-blame, fragility, and at time, the idea that recovery must be earned through lots of intensity.
Are you seeing or hearing this too?
How do you respond when strength becomes the focus? 
🏋️♂️ Littlewood et al., 2016 – SELF Trial (Shoulder Pain)Study: Compared a single, self-managed shoulder exercise to usual physiotherapy care for rotator cuff–related pain.
Key Finding: Pain and function improved significantly in both groups — but no measurable strength gains were observed in the self-managed group.
Takeaway: Recovery doesn’t always require heavy loading. Confidence, consistency, and self-efficacy may matter more.
🦵 Husted et al., 2022 – QUADX-1 Trial (Knee OA)Study: Compared 2, 4, or 6 sessions/week of one simple knee extension exercise for patients eligible for knee replacement.
Key Finding: Pain and function improved across all groups, and 67.5% postponed surgery — despite only modest strength improvements and no clear dose-response.
Takeaway: Simplicity works. Pain relief can happen even with low-dose, home-based movement.
✋ Leong et al., 2015 – Grip Strength & MortalityStudy: Large international prospective cohort study examining grip strength in relation to mortality and cardiovascular disease.
Key Finding: Grip strength was a stronger predictor of mortality than systolic blood pressure.
Takeaway: Strength is a broad health marker — not just about musculoskeletal function, but overall resilience and aging.
🧠 Ben Cormack – Pain vs Fitness Dosing
Content: Blog post outlining how exercise dosage for pain should differ from fitness training.
Key Insight: Pain dosing should focus on tolerance, safety, and self-efficacy, not fatigue, volume, or max effort.
Takeaway: Rehab isn’t the gym. It’s about restoring movement confidence, not chasing performance metrics.
🔗
Read the blog 
Pain often suppresses strength. It’s not gone — it’s just may be inhibited.
And when safety returns, strength does too.
Let’s ensure people in pain don’t feel the need to prove themselves to feel better. They may not need to perform. Or push. Or perfect anything.
Start with calm. Start with belief. Then build whatever comes next.
Because recovery isn’t something we demand from the body — it’s something we create the conditions for.
Stay nerdy,
