This article is one of a four part series looking at exercise modalities to improve pain.  This one discusses strengthening, whilst others introduce the subject, discuss stretching and discuss cardiovascular exercise.

Strength training and pain – traditional throughts

Many people will know that strength training puts load on our muscles and tendons causing stress to these tissues.  In turn our body supercompensates: fascicles become bigger and more numerous, fibre types change and grow.  The purpose of this is so that the next time our body is faced with the same stress, the body copes better.  Its an amazing system and proof of how great our bodies are.

We know from the evidence that strength training works in a whole manner of painful conditions and injuries.   It  out trumps any other treatment most of the time  It is probably one of the most valued treatments in the therapy world.

The case for strength training lies in the fact that either a) weakness causes injury or pain  OR b) weakness develops as a result of injury.  Strength training works therefore by:

• Adding stability – more stability by definition should reduces pain
• Taking pressure off the injured tissue – allowing it to heal or stopping it getting aggravated.
• Making the body better tolerate the demands / loads placed upon it

Strength training and pain – more modern thinking

Although there is a lot of evidence to support the benefits of strength training we have discussed above.  There is an increasing body of evidence suggest that these benefits are only part of the picture when it comes to reducing pain. Strengthening has so much more to offer than local tissue effects.

One of the biggest effects I regularly see is improving mental resilience.  We know from the pain science literature that negative thoughts and beliefs have an enormous effect on pain persisting.  This is particularly true if those negative thoughts include seeing ourselves as weak or vulnerable. Getting strong also makes us feel strong and this can have a huge part to play in recovery.

An example of this is when people get better with six weeks of strengthening exercise. We know that true hypertrophy (muscle strengthening) takes at least twelve weeks, so what can this change be? Simply put it has to be changes to the nervous system that modulates our pain (see my article on pain)

There are plenty of studies out there that have looked in to strengthening programs and have seen huge improvements in pain without improvements to strength.  The mind body connection is a really important thing.

In a similar vein, we also often see strong individuals suffer from pain. Being strong does not preclude people from pain.  Evidence suggests it reduces the risk of pain but being strong alone cannot stop it occurring.  By being strong we have a buffer that means if we place too much demand on our body that it can cope better

Strength training in isolation is unlikely to help already strong people in pain any further.   Unless they have a specific weakness (be careful here as I think this is overdiagnosed e.g. weak glutes, weak core), strong people do not need the physiological changes that strength training brings to get better.

When we probe deeper in to this population what we realise is that often they don’t feel strong, they in some way feel vulnerable or they feel that is something isn’t right. Correcting these views is the key to getting people like this better.  For my money this is best done through education and self-demonstration.  This is best achieved through you’ve guessed it- strength training.  Proving your body can get back to loads of old is just so powerful.  So get back on those deadlifts pronto.

what strengthening should I do?

Strengthening takes on many different forms from core stability to simple bed or chair-based exercises, to Olympic lifting techniques and everywhere in between. What is the best?  In truth there isn’t a best. When studies have compared different strategies, they are often yield similar results. Do what you think will work for you. Do what you think you will enjoy. Do what you think you can sustain.

If you need guidance as to what you should do and how to do it then get some help from a professional.  Physiotherapy are well placed to guide this.  Read here why this is the case.  Make sure you have some input in to what you do and certainly don’t fear strengthening no matter how old you or how much you are in.

Is strength training safe

One concern I often hear about strength training is that it is not safe.  When we talk about strengthening, we are indeed putting extra stress on our bodies but this does not mean it is unsafe. Provided we do it within or just above our limits and build up slowly it is safe.  Heck there are probably 90 year olds out there lifting more than I can lift.

Summary

In summary strengthening can be hugely helpful in treating painful conditions. This is due to the physical effect of strengthening itself as much as it is do with the effects it has on the nervous system and people’s psyches.

In the words of world renowned physiotherapist Adam Meakins:

“YOU CAN’T GO WRONG GETTING STRONG”