“You need to strengthen your ____.” Whether it’s back pain, IT band pain, shin splints, carpal tunnel, or so many other conditions, patients seeking physical therapy for their ills are so frequently told something like this. But there’s a simple, yet significant problem in this: the statement is almost always on the basis that the practitioner believes the problem that is bringing their patient in for help is fundamentally a lack of strength.
I’ll be the first to say that our culture is certainly under active, so much so that generation after generation, the councils that set reference measurements for what a normal range of strength is for a given population have to keep lowering the number to keep it useful (like knowing if someone's grip strength is still lagging behind after an injury or surgery). However...most people we see in the physical therapy space for pain, which was not from an acute accident, haven’t changed their lifestyle or activity level all that much recently (at least until the pain showed up and likely made them scale things back). If they go to the gym, play golf, or play with their kids, they’ve probably been keeping it up at the same frequency as usual (of course some people will have had significant changes recently, but that’s a different situation).
So why is their strength poor enough now to lead to pain or other problems, when their activities are around what they have been for quite some time? The point is that if someone is in fact losing strength without their activity level changing, then there is another problem which needs to be figured out and dealt with. Most of the time, this is something not horribly worrying, which we’re able to track down very easily with a functional neurology skill set and then take care of. Sometimes it may be something far more serious and needs to be investigated.
In either case, sending someone home with strengthening exercises alone is a poor ‘solution,’ which usually only leads to success when it manages to force the body to find a way to compensate around the problem, instead of fixing the cause (and sometimes it does nothing, or even irritates the situation further).
None of this is to say that strength and it’s improvement can’t be part of the overall picture; it certainly comes into play after convolacense, or the atrophy from a broken bone. But in those situations, simply letting the body work its way back to normal activities typically takes care of any strength deficits, and we know why the strength declined in the first place.
Our bottom line is to make sure that in cases where it isn’t so obvious as strength loss from having worn a cast for a couple of months, that we need to find out WHY there has been strength loss and deal with THAT, not just chase the symptom (strength loss). Having a highly sedentary lifestyle can definitely make problems worse, but rarely does it actually cause pain conditions on it’s own (though spending long hours in bad ergonomic positions or with repetitive movements can certainly cause pain, but then it’s still not a strength issue).
It is very likely that a lack of strength, by itself, is not your problem. Having pain? Get in touch and let’s find out what’s causing it, and then put a stop to it.