"You Can't Go
Wrong Getting Strong!"
There’s a phrase that gets thrown around a lot in rehab and strength circles:
“You can’t go wrong getting strong.”
In
Leong et al., 2015 (The Lancet), grip strength was shown to be a stronger predictor of mortality than systolic blood pressure. It’s a global health marker — a reflection of capacity, resilience, and aging. In this context, "you can't wrong getting strong" makes a whole lotta sense right!?!
It’s simple. It’s sticky. And for the most part, it holds up. Strength supports longevity, builds capacity, and helps people feel more in control of their bodies. It also does a whole of good in other ways.
For many, it’s a gateway to confidence, autonomy, hope and a whole host of other secondary benefits: physiological, psychological, cognitive and more.
This statement, tells a story that is uplifting and empowering — that movement can change your life, and that your body can be a source of strength, not suffering.
But here’s the thing:
When that message becomes the entire clinical strategy to help people in pain, we start to lose the plot.
What are patient's saying?
You’ve probably heard it (or said it) before:
“Let’s get you stronger and the pain will go away.”
And patients walk in already believing it. Ask them what they think they need to feel better, and the answers are familiar:
“My core is weak. That’s why my back hurts.”
“My shoulder isn’t strong enough.”
“I need to build leg strength to fix my knees.”
These beliefs sound reasonable. But they aren’t always helpful. What about strong people who have pain? What are they to do? Get more strong.
For some people, there is a quieter message being carried:
“I’m in pain because I’m weak. To get out of pain I need to be strong. That seems like a ton of work."
That story creates room for fragility. Self-blame. And the idea that recovery needs to be earned through significant effort, intensity, and willpower.
In some cases, that approach helps. Building strength can absolutely support pain relief — maybe it improves tissue resilience, provides a novel input, improves motor control, and self-efficacy. It is a story that makes sense to that person and is not cause for concern.
But we also need to acknowledge that this mindset can cut two-ways, and become a barrier. The idea that recovery demands strength may paint an inaccurate picture of what is actually needed for pain relief.
It implies that change must be effortful akin to the effort put into a weekly fitness or spin class.
In
Littlewood et al., 2016 (The SELF trial), patients with rotator cuff–related shoulder pain were randomized to either usual physiotherapy care or a single, self-managed shoulder exercise.
Both groups improved in pain and function. Here's the things ... the self-managed group did so
without measurable strength gains with the authors emphasizing that confidence, consistency, and tolerance were likely key drivers for recovery— not strength.
In
Husted et al., 2022 (QUADX-1 trial), patients with
severe knee osteoarthritis — all eligible for joint replacement — were assigned to do just one home-based knee extension exercise, 2 to 6 times per week for 12 weeks.
Pain and function improved across all groups. 67.5% postponed surgery. Interestingly, the group exercising just twice per week did just as well as those exercising more. Strength improved modestly, but
wasn’t correlated with symptom change.
Pain got better but strength wasn’t the mechanism in both studies.
Pain isn’t just a strength deficit.
It’s a protective output. A perception and an experience shaped by meaning, context, stress, and threat.
In many cases, pain itself inhibits strength.
Have you ever tried to lift your head off the pillow when you have a headache?
Have you ever tried to lift something with super painful back?
It's not easy, it's hard to find the strength. Not because something is damaged, but because the nervous system is protecting. And when pain settles — through time, reassurance, safety, and movement that feels doable — strength and capacity for movement often returns. Not because it was trained, but because it’s no longer being held back.
This is one reason why we have to distinguish:
Exercise for pain ≠ exercise for fitness.
Rehab isn’t about hitting 3 sets of 10 or chasing progressive overload. It’s about restoring trust in movement — helping the person tap into the analgesic effects of exercise, feeling safe and reassured, competent, and capable in their body again.
When we treat pain like a performance problem, we risk reinforcing the wrong narrative — that you’re broken, undertrained, or not trying hard enough.
So let’s reframe it.
Strength training exercises are a valuable tool in rehab. But building strength is not prerequisite for recovery.
You don’t have to grind to feel better.
You don’t have to prove yourself to get out of pain.
Sometimes, the first rep isn’t about effort.
Let’s make sure people in pain don’t feel like they need to perform their way back to health.
Because sometimes, recovery begins when we give them permission to stop trying so hard — and remind them they already have what they need to start healing.
Patient Story
The “Weak Core” Belief
I had a patient come in with persistent low back pain. They’d been dealing with it for months, and during the intake they told me, almost with certainty:
“I know it’s because my core is weak. I just need to strengthen it and the pain will go away.”
This belief wasn’t coming from nowhere — they’d heard it from friends, seen it on social media, maybe even picked it up from past appointments. And while it sounds logical, it’s not the full picture.
So I offered a reframe:
“That’s a really common belief — but here’s something interesting: strong people get back pain too. Olympic lifters, CrossFitters, professional athletes… some of the strongest people out there still deal with pain. So we know it’s not just about strength.”
Then I shifted the focus:
“We don’t need to ‘build strength’ in the traditional sense to get out of pain. What we need is to get you moving in ways that feel manageable and repeatable — something you can stick with. Let’s find some general exercise at home you can do along with some targeted movements to help the area settle down and rebuild capacity.”
As we progressed, the patient started feeling better the next day— not because they suddenly had a “strong core,” but because they were moving more, worrying less, and rebuilding trust in their body.
That’s the shift:
From trying to fix weakness to restoring movement and confidence.
From overthinking strength to focusing on consistency and momentum.
In the end, it’s not about avoiding hard work — it’s about making the work meaningful. We start where they are, and we build from there.
Summary!
So… can you go wrong getting strong?
Not really. Strength has a long list of benefits — for longevity, injury prevention, and overall resilience. It’s a great public health message, and a worthy long-term goal for many people.
But in the context of pain, especially persistent pain, strength alone isn’t always the answer.
When strength becomes the only explanation for pain — or the only solution — we miss the opportunity to meet people where they are and limit the many paths forward that are available.
Let’s remind our patients that strength is one tool in a much bigger toolkit — and that progress starts not with fixing weakness, but with restoring movement, confidence, and clarity.
The Clinician’s Guide to Exercise and Pain
Evidence-based tools and strategies to confidently support safe, effective movement in people in pain.
Build stronger, more meaningful therapeutic relationships with insights from top clinical experts.
Sean Overin, MPT, tDPT Registered Physiotherapist
