Strength Training is (and as) Physical Therapy

“The belief that physiotherapy exercises have to be different from simple strengthening exercises is still common…. This is both sad and disappointing.” - Adam Meakins[1].

Often when we think of strength training, we immediately envision folks in the gym lifting heavy weights or perhaps getting really bulky or chiseled like a statue. But what if there is WAY more to strength training than bulking up, losing weight, getting that six pack, etc? What if it could also serve as rehabilitation from injury?

At Resilient Body, we believe that strength training and physical therapy can actually be synonymous. Yes- that’s right! Injury prevention too? Also, yes! It does not need to be that one comes before the other in either prehab (bulletproofing) or rehab (recovering) scenarios and this is an important unification that is often not presented or understood. Afterall, isn’t all strength development functional? Is it ever a deficit or problem in health, longevity, or fitness? Arguably it can be the most foundational and valuable component of fitness and injury rehabilitation/mitigation.

Furthermore, the way strength training type exercises are used in both scenarios may not need to differ as much as they currently do when in a clinic by a therapist versus the gym floor by a trainer. Some of strength training’s essential keys are its roles in (re)gaining range of motion, and motor control moving from local to more global patterns (think a squat or running stride), and then gaining more control and ability to push further with better resistance to external forces. Many of the training techniques used in the gym versus a physical therapy may address aim to address just that, yet they often needlessly differ so much in prescription. We think that a quality strength training program should look more similar for both and indeed can be the same. When designed appropriately for the individual there is progression in the ability to stabilize and control greater loads and forces all while helping to increase the health and range of motion for your joints at the very same time.

Some Relevant Terms: Stabilization, Load Management and Global Patterns…

Stability, something we seek in a variety of aspects of our lives, but in the context of movement is quite beneficial in injury prevention and recovery. If we are able to create stability in our movements we are able to improve safety and performance both. This ensures we can steadily move in and out of positions while engaging in daily life tasks, hobbies, sport, and fitness training (strength, cardio, calisthenics, etc.). Stability ties into load management and these two go hand in hand. With better stabilization comes increased ability to manage loads (like weights) and resist forces (like catching yourself in a fall skiing without tweaking your arm).

Load management can be in reference to literal weight, duration, frequency and intensity, as when we are better able to control and stabilize we can push these boundaries with less risk to injury. Load management is also tied to our physiological and psychological well-being. Meaning to say different types of stressors applied to these can also affect our bodies during workouts.

As briefly mentioned, global patterns refer to muscle patterns that are affecting/using multiple joints and are utilizing local components/patterns that are closer to the joint and often engage as part of or prior to movement. Think of the global pattern like a whole chain and the local a link in the chain, or in an example of a squat as the global pattern while the flexion/extension of the hips being local (others could be knee flexion/extension, ankle flexion, etc). When we stabilize and gain better control of local parts, we can also work to integrate more solid global patterns. A takeaway here will be that HOW we perform or progress a global pattern can be all we need. In other words the SQUATTING ITSELF CAN BE THERAPY without a bunch of parsed exercises to get you there. This of course depends on the individual and the type of squat. But first a quick dip into Range of Motion (ROM).

A Quick Review!

Range of Motion (ROM) and Active Range of Motion (AROM) which we are most concerned with…

For a more in depth look at these fundamentals check out our previous blog post here!

Range of motion refers to your range of movement or space you possess, typically in reference to you your major joints (hips, shoulders, knees, etc.).

Active range of motions refers to your ability to actively control your body’s movements.

If you haven’t picked it up yet, CONTROL is what we aim to emphasize here. When you learn to actually control the range of motion first with the requisite motor control and then develop the stability and strength to go with it, this is where things really take off, where recovery can occur, and where resiliency is truly built. This is also where we find the intersection with rehabilitation!

Some Key Benefits of Strength Training:

-          Muscle memory! Adding to your muscle cell nuclei (myonuclei) can permanently improve the muscle cells and reduce the atrophy that can occur in unused muscles. [2]

-          Facilitates ease in health, fitness and weight loss and can even replace certain cardio exercises that run the risk of creating repetitive stress/ strain injuries (e.g. plantar fasciitis, shin splints, knee/ankle tears or sprains)*. Increased muscle can even help regulate things like blood sugar, inflammation and mental health.
*Strength training is not immune from causing RSIs.

-          There are enough variations of how one can strength train that anyone can do it! From body weight training, machines, free weights, resistance bands, blood flow restriction, to suspension there is always a way to help work around injury if needed .

-          Resilience! Our eponymous brand resonates deeply with the idea that building up resilience is a key component to your fitness journey AND in recovery. Strength training can increase resiliency by establishing greater proprioception, stability, control, and ability to resist forces that can also cause injury thereby decreasing your risk.

-          Much More!

As noted above there are quite a few important benefits of strength training that you may be able to tell can help both in the realm of gaining and maintaining strength as well as recovering from injury or dysfunction.

Use it or lose it?!...

Not exactly thanks to muscle memory! It has been shown, doubly, that the nuclei (think of them like a general managers) in charge of muscle cells do not just die off. It was previously thought to be the case but this die off may have actually been for other parts of the muscle cells since muscle cells are quite unlike other cells in the body. So if you are concerned about losing your hard earned progress or not getting back to where you once were after an injury, you can breathe a sigh of relief. Equally Important to note is that you can work to gain more nuclei and better bulletproof against injury since you will have a better foundation to return to.

Muscle for health not cardio…

While we are certainly huge fans of cardio, strength training has also been shown to be just as effective as cardio (if not more so) for weight loss and metabolic health and has the ability to reduce inflammation and improve mental health too. This is also aside from possible reduction in repetitive stress injuries (which can still happen in strength training, as with cyclical “cardio” type activities); BUT we are bolstering our body’s tissues and systems for that cardio while doing strength training as well. You may even consider it foundational to certain types of cardio. As is the often cited quote, “You can’t fire a cannon from a canoe.”

All of these factors are not only important in a prehab scenario while trying to achieve our healthiest version of ourselves, but also in staving off sickness and injury. We can also look at this as a recovery from injury standpoint and see that strength training before and during recovery (being smart with how we adapt exercises) can help us recover more quickly as well, due to the same factors. If you are in better shape metabolically, mentally, and have less systemic inflammation beyond what is necessary for the healing process, you may just find yourself bouncing back a lot more quickly.

Variations and graded exposure…

There are not only tons of variants to any given movement in strength training, but levels within. Think of a deadlift and all the different types of related hinging movements there are: Romanian, conventional, sumo, single-leg, hand-supported, cross-body, good-mornings, seated good-mornings, seated sumo good-mornings. Also, consider how you may be able to take each one of these and change how much range you use and what load you use in doing each. For one person recovering from a back injury, it may actually be okay for them to use a moderate load in a conventional set-up, while another person may only be able to handle light loads in a very limited range sumo deadlift off blocks.

For person A we may consider either gradually increasing load and complexity (moving to single leg, anti-rotation, rotation, and/or more weight on the bar). For person B it may be getting a little more range week by week. In both scenarios, we are grading the exposure to more and more stress using one or more variables like load, range, or complexity though we can do this many way and it does not have to be small build-up, chunked pieces, or components of a deadlift. While there are scenarios where we may start off without load or try to support our body in different positions using muscles of the hips and spine, often times it might just be okay to just do the damn deadlift!

Interestingly this is also how we may describe initially progressing someone along in their strength journey since a novice trainee will likely not enter training being able to rip heavy weights or hinge on one or maybe even two legs at a time. It is through graded exposure to increasing stress that our body must then learn to adapt to. There is where we elicit in our physiological and physical changes we have set out to accomplish.

And in this lies our resiliency and ability to create more in strength…

As you can see, whether we are looking at strength training as a way to gradually rebuild the capacity for stress/load for someone after an injury to regain previous capacity, or as a way to gain the capacity to begin with for a novice starting their strength journey, they really are one in the same along different points on a continuum.

There is no real divide in practice whether we are aiming to rehab someone with a shoulder injury recovering from surgery that has their overhead reach to 140 degrees, or a more sedentary person without injury who has the same active range of motion. If neither can reach to their fullest overhead position, even without any resistance, then we must help them get there either way; and strength training gives us that path to get there!

The way the stress is applied, how quickly, along with how quickly someone adapts may differ slightly. Nevertheless, gradually exposing that shoulder to stress and building range, control and strength is key. All need to happen for that shoulder to truly be healthy and resilient.

Moving from passive to active control with strength is a huge part of what we focus on with all our clients. We work with people recovering from an injuries, training for the first time, long time gym rats, in specialized FRC sessions, homework given after a manual therapy session, all in the natural progression of getting stronger.

If you can start to re-conceptualize how you view strength and see that it is not just lifting weights but so much more, you can learn to truly appreciate it for its therapeutic properties and myriad benefits.

[1] https://www.facebook.com/TheSportPhysio/photos/a.1275786569120652/2661496850549610 Adam Meakins Facebook Blog Post

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356110/ Lawrence M Schwartz
“Skeletal Muscles Do Not Undergo Apoptosis During Either Atrophy or Programmed Cell Death-Revisiting the Myonuclear Domain Hypothesis”