Episode 57: Why "Getting Stronger" is a Lazy Answer for Your Pain

Just strengthen your quads and hamstrings." If you have ever gone to an ortho or PT for knee pain, you have probably heard this advice. But does it actually make sense?

In this episode, We discuss why "getting stronger" is often a lazy and ineffective strategy for resolving pain. Inspired by a recent editorial by Jared Powell titled "It is not all about strength," the hosts break down why pain is rarely about muscle size and almost always about position.

They explore the difference between "Hardware" (structural damage) and "Software" (movement patterns), why MRI findings are often misleading, and why surgery should be the last resort—not the first option. Whether you are a college athlete or an "industrial athlete," this episode will challenge the way you think about rehab.

In This Episode, We Cover:

• The Strength Myth: Why "get stronger" fails active people who are already squatting heavy but still have pain.
• Position Over Power: Why pain relief often comes from changing how you move, not how much you lift.
• Hardware vs. Software: Why you can fix a "Hardware" problem (surgery) but still have pain if you don't fix the "Software" (movement patterns).
• The "Industrial Athlete": Why factory workers and tradesmen need to view their bodies like elite athletes to avoid injury.
• Surgery Reality Check: Why getting surgery doesn't guarantee a fix, and why you should exhaust your conservative options first.
• Return to Sport: Why athletes often "cram" for preseason and end up injured, and the realistic timelines for tissue healing.

Resources Mentioned:

• Editorial: "It is not all about strength: Rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief" by Jared Powell.
• Concepts: Hardware vs. Software in Injury Rehab.

Connect with Us: If you enjoyed this episode, please leave us a review on your listening platform or subscribe to our YouTube channel!

Disclaimer: Although we are healthcare providers, we are not YOUR healthcare provider. Content is for educational purposes only. Please consult your physician before making lifestyle changes.

Transcript

Speaker: 0:01

Welcome to the podcast, the professionals providing insight so that you can go fix yourself. The GFI podcast hosted by Mike Bruno, a chiropractor and athletic trainer. And me, Michael Stanton, an athletic trainer certified strength conditioning specialist. Although we are healthcare providers, we are not your healthcare provider. We will discuss general health interventions in this podcast, but you should not take that as health advice that works in every situation. Before doing anything on your changes, please consult with This podcast and this podcast jobs and our own opinions. If you're enjoying the podcast, please leave us a review on your listening platform and or like subscribe to our podcast at YouTube. Links to our show can be found in the show notes on any platform that you are listening to today. First off, I'm pissed off at the stonewalled not being able to But today we're talking. We're talking about strength. I'll give a shout out to the It the it's actually an Um, Jared Powell is the lead I don't know him. Um, it's actually, you know, his Jared Powell physio at That's about all the information Um, and the title is it is not mechanistic assumptions in for musculoskeletal pain relief. They need cooler names for Sometimes people get really Um, if you remember Brian Catania, he would always like want to get creative with like titles and stuff that he wanted to do. That that's a throwback. That guy. Yeah. Wow. Good dude. Look up dude. Great dude. Yeah. Shout out slings. Shout out slings. You still talk about those. Like every once in a while I incorporate some here there. Like if I don't know if the theory I still go about it and we're not going to dig dig in on the theory. But I think it does kind of go it's not all about strength. Um, and I always like going back to a story is my first or second year as a GA at Sacred Heart, and it had a lacrosse athlete knee pain and was like, all right, well, we'll refer you to the ortho and kind of see what's going on. And ortho Caesar looks at her. All right, you're just going to do quad and hamstring strengthening. And in my head it didn't make And like yeah look because I was like back squatting a decent Like she's she's doing like all little bit of pain. And quads and hamstrings are probably always doing something here. I don't know if that's it. Like I remember I got that another time, like a football athlete. Oh yeah. Strengthen their quads and And you see like their thighs times the size of your head. Yeah, I get I get pretty just getting stronger is such a active people like that. A lot of people I work with are And like, how much stronger do Like, I'm going to the gym six And the analogy that seems to it's not about getting stronger, into positions to use the So it's in there. You just can't use it right now for the reasons of pain, limited range of motion, things like that. Yeah. And I feel like anytime I talk to someone, say you do an intervention, it's manual therapy. It's, hey, we're going to do like we're going to have you move this specific way to do that reposition. And if you get pain relief not strength like we know. We know right there off the bat Yeah. Like a straight up is my muscle because we just showed you that it was a strength issue. How long does it take to It takes four to six weeks. It takes a very long time to do Right. That's the only time you're probably truly looking at strengthening is either someone's truly deconditioned like they haven't done anything for months or it's post-surgical. That's I always say, like, if fresh off a surgery, that's Good advice. Outside of that, it gets really And we talk about all right. So like when you're working with about that base build before. But it's like all right four to We're working. We're getting you out of pain. We're improving some things. The next four to six weeks, we're really laying down the foundation on how to move better. Then after that, yeah. Then the goal is strength. Then the goal is power. That's how we're going to really you're actually going to improve One hundred percent. And when when we talk about population, some people don't And I say performance means something different to every person. Performance for grandma could be playing with the grandkids. In her world, she's an athlete She doesn't have to be on the field in front of thousands of people to be considered an athlete. And I think that's where a lot the private sector because going to poke on this. Does it hurt? Cool. Let's do some stuff. Let's poke it again. Does it hurt? No. Okay. You're cleared. Go do whatever. And you're just missing steps is doing them a disservice. And they're going to end up months later because you didn't You just temporarily, like, Yeah. When I was and I still, I still that I work at. You know, we call them Um, I just I just found that Yeah. You know that factory. Factory I worked at? I gotta keep an industrial Yeah, industrial athletes. That's how we refer to them as. Because we're, like, trying to putting in their mind that, doing is actually pretty taxing. Like and like performance for Performance for you is very like it's your livelihood in this setting. So we want to make sure that, you know, you can return to work, get work, conditioned, all that stuff. I was talking to a guy yesterday job, he's in construction and And then also he's like, I won't around my house. Like it's always me. I'm like, okay, so like, if your underneath your sink like your Like there's there's a secondary back pain that he was aware of, You know, it's a lot of figuring A lot of people are scared to It's like a train wreck. You're like kind of like half And they're like when you ask, hey, I just want to get out of pain. No one really thinks past that. So the conversation stays and the clinician, where, okay, determining that a success. But you get out of pain and you And there was no prep work done Then you're going to be super end of the day because you problem you want. Yeah, and it's funny, I always take it up to like the college athletes because I've worked with so many probably I don't want to call it higher level, but higher level college athletes. Where? How did you get a scholarship? But you know, the amount of prevalent in like my spring done the sport. They're very beat up. And it's like, okay, well then, their exit physical or whatnot. It's like, well you got the So, you know, just take off and come back and you should be fine. The batting average was zero on anyone coming back and actually being ready to like get back into sport or anything like that. And, you know, partly because would say it's on me for not plan for them. But it's also like, oh, well, all they need. And they would do go to TW, they would probably just do like whatever tabletop exercises there were. Then there was like never a plan you ready for the conditioning for the fall season as a in as a preseason conditioning as almost Oh yeah. These kids think that they can They thought that they could. And it's it's a big like looking at it. And if you think it can only get the results that you want in cram as much effort into those you're gonna end up throwing up Yeah. Versus if you trained consistently for the three months that you were off, then that's going to get you to a much better level where you're comfortable on that field and you're like, you're working hard, but you're feeling good and you'll actually probably get a benefit out of that preseason conditioning. Yeah. Burying yourself. Yeah. That's where I will say, like helped me a lot on like how long back because everything in injury standpoint, is If you don't throw a baseball to get back to where you were. If it's two weeks, you write a If it's three weeks, it's six If it's a month, it's three Like, right. That that is especially from a players can get away with a don't have to throw as hard. But from a from a pitcher's the programs had to be set. The issue is that that is very well in baseball. And like most people, I wouldn't say it's really hit the youth levels. People still kind of do where It's probably why we keep having levels it's people doing But, um, in the college and pro level, that realization is already there. And it has kind of happened in soccer, probably like anytime point, it's, hey, we got to that to kind of get you ready Yeah. I mean, in the soccer is we only have them in that Yeah. So these kids are year round with their clubs and they could tweak their hamstring on day one with us. We have a game Friday like Yeah. So what can we do to like, actually get them on the field then? That's definitely a rush job. Not rush job in the sense where we're never on the field like unsafely. Yeah, but the whole goal is here for two weeks. Like, you gotta play Friday. Or if you want to play like, have to go through. And on Thursday, if you're not passing our tests like you're not playing. Yeah. And like those, those those are It's like they could also pass They can be functionally good, but they get into the real environment and they react like, right. There's still a risk. Yeah. Reason why you want to take a stuff is at the end of the day, that risk of re-injury? Yeah. Nobody has patience. Nobody has patience anymore. No. With regards to respecting what's going on in the healing process, it's very well researched. It's very well documented how long it takes for tissue healing to happen, especially so like when we're talking acute injuries and everything in chronic injuries where people like don't know where it came from. That's where the big question I'm sure a lot of clinicians are We taught this in school and they're like, hey, when someone asks, how long is this going to take? You don't give them a straight No. Yeah. You try to and like, yeah, like To be honest, I don't like But what I like saying is they told me four weeks and it's, you I'm not better. Yeah. The I like to give people a get their head around it. So the first phase, like we're get out of pain. That's going to take roughly Then we're focused on once we're better, we're going to build That's also going to take Then we can talk about But if you're in week two pickleball drills and you're you're going to be pissed off. And it's more because we just Yeah. And I don't think a lot of like like it's even and it's know, they go see your primary sports med doc, like they don't They just go, this is what it You're out for two weeks. Like follow up with me if you So they don't they don't have to Like how can you have that the guy for five minutes? Yeah, a lot of people that I've worked with who have spoken with in ortho or primary care person prior, their story is relatively the same when they go in and they get maybe five minutes with the doctor just for him to say, oh, you're good, or oh, you're not. Like, we should talk about Yeah. You didn't really have a You just looked at me like a Determined if the part was still And if it is, then you're going And if it's not, then it's like, hey, go get surgery to get it reattached. There's so many other options in Yeah, I've had I've had people to me with to happen where I'll they'll say, yeah, you know, It feels slow, but like I'm I gotta follow up with the I'm all right. Let me know how it goes. They come back. Okay. I got surgery scheduled next I'm always just like. Why? Like how? I thought you said you were Yeah, but it's taken a while, And he felt like it wasn't going to get much better after after this. So that's what we did. That happens that that happens. Yeah. Like if, if they came to see one conversation like, hey, you're Or like if running's a thing, for three months. Like, let's put that out there, Then it's like, okay, are you on board with a plan that's going to ultimately get us back to running? But the short term negative or term is that I have to lay off Sometimes people will be like, surgery today and then be back The outcome and the timeline still the same, but the surgery has that perceived like it fixes. Almost guaranteed it's going to You'll be good for forever because we did the surgery, which, like all the research says, to say it's a knee surgery. It's you're getting arthritis. Probably like as soon as you as soon as you go in, you're getting arthritis. I had a client the other day who's, um, dealing with a really bad flare up of a long standing disc issue. And he's like, I would never or injections or anything, but Like, I'm considering surgery And he's gone through all the He's gone through it the right And I was like, dude, you are a Like, it's there for a reason. Yeah, you can definitely get It's like it's like there's no That's why it's a thing. The problem is that if that's like that group of people who, like, truly need it and it works for them is like this big, the people who actually get it is a lot better. And that's that's yeah, that's because I've had an equal amount pool, get surgery, do the rehab, problem as when they went in? Yeah. And how would you be if that. Yeah. One of those lacrosse athletes Um, I think it I think they whatever that word. Yeah, yeah. Uh, she said she wished she. She said she wished she never got the surgery and never felt better. Like it was all the same stuff. And then she had to go through rehabbing from a surgery. So nothing got better. Yeah. It's crazy. I have a guy who's been through crazy amount of arthritis in his His knee pops and clicks and If we get him in the if we get him in the right position, he's able to have no knee pain and no clunking. So it's like, okay, there's a we can scale that. But there's going to take a dude, buckle up this, you're in Yeah. Okay. Let's let's ride like this is Like, just like he's a guy who No problem. But he's terrified of stairs. You know what I mean? So. So it's one of those. It's not a strength problem type He's the definition. Yeah. He is the definition of if you hundred pounds but your knee It's not a strength problem It's a position problem. So being able to get into positions in that specific environment to be able to do pain free stairs, there's a learning process involved with that. There's there's a lot of stuff like surgery, pills or whatever it's, hey, my knee hurts going hurt when I squat. Which means that even if there's a structural problem, fixing that structural problem isn't going to solve the problem because you have a pain free environment and you have a painful environment. If it was painful across the maybe surgery is on the table anything to get out of pain. But that's not the case in a lot A lot of people can find a pain And then from there you just scale that and make it more and more pain free across more environments. Yeah. And that's how you avoid Bing bang boom. Yeah. Because it's funny. Because even with the surgery, and they're like, yeah, yeah, something there, but like, yeah, clean your knee out like that. That's like the typical one that I don't like it. Me personally, I'm like, I don't if I ever have to do it. Like, yeah, that sounds brutal. Yeah. It's not like a, like a like you just like spilled something on the floor. It's like, oh, let me just mop That's not how. That's not how the joints work Yeah. And the amount of people I know or x ray findings and no pain is have no findings on their MRI like, hey, what you see on your pain is a conversation. I should probably tattoo it on I have that conversation. But people are scared that structural damage is almost is a death sentence and guarantees pain and discomfort and dysfunction. All this stuff over time and again, there is a there is a small section of those people who are absolutely right and they should get surgery right, but you have to be able to have that conversation with them, explain all of their options, and then they can make that decision themselves. Yeah. If you if the person is not in like, oh, you should get surgery to get worse. They're probably going to be they're going to jump right in Neither of those things in that Yeah. Well, even that I think that's a A lot of people don't get all table because there are more and it's even on healthcare They don't know all the options. They don't know where else. Definitely on that. Yeah. Like it's yeah, it's it's on us like point people in the right. Navigate your health. Um. Your health. Shameless plug. Shameless plug. You're absolutely right. If they. If someone goes and gets But I could have helped them And they ultimately didn't want And that surgery fails. That's on me. Yeah. Not being able to explain their now, if they were completely were like, I'm just going to How much more can I do? It's your health, right? Yeah, but if I just didn't tell, like, why didn't you tell me I That's that's that's a with your clinician. Yeah. For sure. Yeah, I think quick hitters. We got anything else? I'm heated. Yeah. Um. Talk you off the ledge. Oh, man. I'm going to go hit my first. I'm gonna go hit my first run of you're supposed to do yesterday. But yesterday was a long day in Oh, it's so dark. And I'm sure it's this way in But in new Jersey, I woke up at I would need a flashlight on my I run with a body light. I knew you would. Yeah. Make the excuse breaker. Yep. How far ahead can you see in Oh. Pretty far. Like, I'm very comfortable with You're gonna have to send me the I also, I have a I have a light Hold on. What, do you run like this? I mean, like, but you could see it, I guess, going back and forth. But no, I don't. I don't actually use the watch I just use the body light. Mm. Okay. Well, it's light out now, so Yeah. Knock it out. It'll be fun. Five k goal of a sub twenty five Which would be running as fast actually tested a five case. I don't know what that would be Dude five games are fun. They are going to be all like like like family races. Like you got a kid. Now you're going to be doing Like, who knows if you're going to have time for marathons anymore? Yeah, exactly. All right. I got speaking of which, I gotta So go fix yourself.