Strength Training = Value-Based Care

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The older I get, the more my friends and family are aging alongside me. I know, I’m “Captain Obvious.” But with age come the aches and pains and injuries seemingly out of nowhere.

Since I’m a PT, I get a lot of questions related to pain by friends and family, too. They want answers and they want the pain to go away. I don’t necessarily mean pain because of overuse related to targeted exercise routines. I mean pain in relatively sedentary people who have either lapsed in their exercise routine or have never had an exercise routine.

Some have been “cardio junkies,” but are slowing with that as they age and haven’t transitioned to much more strength training.

“I pulled my back lifting firewood.”

“Everything hurts when I sit for too long.”

“My lower back is tight.”

“My shoulder hurts since I rearranged my closet shelves last week.”

“When I get up, my knee clicks.”

After ruling out something more serious, I tell them why they may have pain based on their description and then I almost always tell them, as part of our conversation, that they likely need to start strength training.

Strength training is part of the vast majority of treatment regimens prescribed by physical therapists.

We often call it “therapeutic exercise” when we are working with patients directly, because it’s properly dosed and controlled and specific and individualized.

There one big problem. People who haven’t done much strength training aren’t so inclined to start in middle-ish age or older adulthood. But it’s worth every minute of time for the dividends it pays over time.

However, it takes time, effort, consistency, and most importantly, a TRUE belief that it will pay dividends over anything else they could do to get the lasting results they want (and not have to come see the PT anytime in the near future).

Here are Three Ways Strength Training is Beneficial for Pain Management, Recovery from Injury, and Injury Prevention

It can accelerate the recovery process. 

Strength training improves blood flow to the injured area, delivering healing nutrients while simultaneously and efficiently removing waste products. Resistance exercises expand blood vessels, optimizing blood supply and oxygenation. It also triggers the release of myokines, which have anti-inflammatory properties, and can help reduce inflammation and speed recovery.

What people usually expect is that massage or ice or heat or stretching is needed to help reduce pain and improvement and function. While rehab is typically multi-modal, strength training via therapeutic exercise early in treatment is important for both short and long-term benefits.

It can correct muscle imbalances.

Sounds like a catchy thing to say, right? Muscle imbalance? Yes. It occurs when there is inequality of muscle length and/or strength between opposing muscles. It impairs the that allows for normal, pain-free movement and function. It then causes tissue changes, inappropriate movement patterns, and functional impairments.

We get them by repetitive movements, poor posture, prolonged sitting, and more. Muscle imbalances often offer signs before they lead to pain, like stiffness, impaired flexibility, postural abnormalities, etc.

The below is a simple visualization of “upper cross syndrome.” It consists of tight and weakness of the muscles of the neck, shoulders, and upper back that cross between the front and back of the body. It impairs muscle activation, movement patterns of the head, neck, shoulders, and back. Scapular winging, thoracic kyphosis, protracted, elevated shoulders, forward head posture, and more are all indicative of “upper cross syndrome.”

It can lead to headaches, neck pain, chest pain, limited range of shoulder motion, shoulder pain (especially overhead), cervicothoracic dysfunction, and more. The most common cause is prolonged poor posture, so correcting posture is a typical part of a treatment plan.

In an article in the journal Healthcare, published in August of 2023, the authors completed a narrative systematic review of literature to identify effective treatment programs. Here’s what they found: various exercises and techniques that improve posture and restore neuromuscular imbalances are effective treatment modalities for addressing pain and impairments.

Skeletal muscles have counterparts. 

Biceps/triceps

Quadriceps/hamstrings

There are also imbalances between the left and right sides of the body that can lead to pain and injury.

It’s common not to have the right balance in strength between opposing muscles or sides of the body. This can lead to injuries over time. 

Muscle imbalances are also common in physically fit and strong, active people, too. One quick example: a distance runner with patellofemoral pain syndrome (PFPS)/”runner’s knee,” or pain at the insertion of the quadriceps tendon on the tibial tuberosity, is often caused by weak quadriceps muscles.

Yes, a runner can have “weak” quadriceps muscles. Think “weak” in the context of insufficient strength to support the endurance exercise of running.

It can help prevent injuries.

We talked about addressing muscle imbalances to prevent and treat pain and dysfunction. But what does strength training actually do that helps prevent injuries?

Strengthening improves the endurance and power of muscles. It stabilizes joints. It protects tendons.

For example, a painful muscular injury can occur during a repetitive activity where a weak and often imbalanced muscle group is taxed over a period of specific activity. Here’s one shared with me just this week:

Someone who sits in front of a computer for prolonged periods with forward head posture carried loads of firewood up a flight of stairs for several hours. Near the end of this taxing effort, they feel a strong pain begin in their middle right back.

This may be a mid-back strain. It is often treated by addressing the pain by oral and/or topical care, and by exercises to improve range of motion, strength, flexibility, and muscle balance.

How to prevent this? Proper posture, consistent strengthening of the core muscles of the body, including the mid-back muscles, good scapular stability, warming up before the activity, taking breaks during activity.

Strength training and value-based care—is this a stretch?

I talk a lot about value-based care from the perspective of the healthcare delivery system and alternative payment models.

But investing personal time and energy into high-value activities like strength training that pay dividends over time. Strength training is a truly effective way of reducing avoidable healthcare spend and, more importantly, reducing pain, loss of flexibility, and loss of function over time.

And there are also few professionals better equipped to help get you started in your strength-training journey than physical therapists! 😀 They are ideal for helping people improve their strength and fitness while taking into account and helping address muscle imbalances, postural abnormalities, range of motion limitation, and so much more!