Strengthening is Not Always the Answer

In the world of physical therapy, there’s a common trend that I’ve noticed: therapists piling on a variety of strength exercises in the hope that painful joints will miraculously heal. While this approach might work in some situations, it’s far from a universal solution. In fact, more often than not, this "shotgun" method misses the mark entirely, leaving patients frustrated and still in pain.

Don’t get me wrong, strengthening exercises are invaluable in certain contexts. For example, post-surgical patients often rely on these exercises to regain functional mobility or return to their sport. But when it comes to low-grade joint pain—the type that feels nebulous and tricky to pin down—strengthening alone is rarely the silver bullet.

A Real-World Example

Take a recent case I encountered at my clinic: a 17-year-old female came in with right hip pain. Her goal? To run 18 miles on her 18th birthday. During her initial evaluation, her glutes tested weak. Following the standard protocol, her previous therapist assigned a series of strength exercises to address the impairment. Sounds straightforward, right? Weakness equals strengthening. Problem solved.

Except it wasn’t. After four sessions of this regimen, her symptoms had worsened. Walking became more painful, and she felt further from her goal than ever. When I took over her care, I reassessed her condition and diagnosed her with gluteal tendonitis. Instead of persisting with strengthening exercises, I focused on targeted treatments: deep tissue massage and a stretching program. After just one session, her symptoms resolved completely, and she was back to running pain-free.

The Bigger Lesson

This case is a reminder that strengthening is not a cure-all. When every injury or pain point is treated with the same approach, you risk ignoring the unique nuances of each patient’s condition.

Clinical assessment skills and a proper diagnosis are your greatest tools. By understanding and addressing the underlying diagnosis—not just the impairment—you’re far more likely to achieve lasting results.

So, next time you’re faced with a challenging case, resist the urge to default to strengthening exercises. Instead, take a step back. Listen to your patient, reassess their symptoms, and let their diagnosis guide your treatment plan.

Explore Further

If this resonates with you, check out my other posts on the importance of treating diagnoses versus impairments, as well as clinical patterns for common outpatient orthopedic conditions. Let’s refine our practice together and truly make a difference for our patients.