When most people think of physical therapy, they imagine stretching tight muscles, a therapist
guiding careful movements, or perhaps machines humming softly in the background. These
images aren’t wrong—but they only capture a small part of the picture.
One of the most powerful, evidence-based tools in a physical therapist’s toolbox is strength
training. Resistance training isn’t just for bodybuilders or athletes. It’s a critical part of
rehabilitation and long-term musculoskeletal health for patients of all ages and conditions.
In this article, we’ll explore the importance of strength training in physical therapy, the science
behind it, and how it plays a central role in restoring function, preventing injury, and promoting
lasting recovery.
Strength Training in Physical Therapy
Strength training involves exercises that improve muscular strength, endurance, and power by
working against some form of resistance—this could be bodyweight, resistance bands,
dumbbells, cable machines, or even water resistance. In the context of physical therapy, the goal
is not to just to build muscle, but to:
- Restore functional movement
- Improve joint stability
- Reduce pain
- Build resilience to future injury
- Improve movement efficiency and confidence
The physiological benefits of resistance training are well-documented. It improves muscle fiber
recruitment, enhances tendon stiffness and durability, increases bone density, and positively
influences neuromuscular control. In practice, this means patients move better, feel stronger, and
return to daily activities or sport with reduced risk of reinjury.
For years, rest was commonly prescribed after injury. We now know that extended periods of
inactivity often lead to muscle atrophy, joint stiffness, poor circulation, and even delayed healing.
Today’s rehabilitation model prioritizes active recovery, with progressive resistance training at
the core.
Whether someone is recovering from rotator cuff surgery, experiencing chronic low back pain, or
managing age-related muscle loss, structured strength training is often the safest and most
effective way to regain lost function.
Current Clinical Practice Guidelines (CPGs), such as those published by the American Physical
Therapy Association (APTA), consistently recommend strength training for conditions ranging
from knee osteoarthritis to chronic neck and shoulder pain.
Finding the Right Load
One critical but often overlooked aspect of strength training in rehabilitation is the importance
of using appropriate resistance.
For strength gains and tissue adaptation to occur, resistance must be challenging enough to
create a stimulus. Too little resistance, and the body won’t respond. Too much resistance, and
the patient may experience pain, breakdown in form, or setbacks in recovery.
This is why physical therapists carefully assess and prescribe resistance based on:
- The patient’s current strength level and tolerance
- The specific tissue healing timeline (e.g., tendon repair vs. muscle strain)
- The movement pattern and target muscle group
- The desired adaptation (endurance vs. hypertrophy vs. maximal strength)
Therapists often use tools like repetition maximums (RMs), rate of perceived exertion (RPE)
scales, and performance testing to identify the optimal load for each exercise. For example, a
patient might be prescribed a resistance that allows 10-12 high-quality repetitions before
fatigue—but not 20+ repetitions, which would fall more into the endurance range and fail to
stimulate meaningful strength gains.
Using the right load not only accelerates recovery, it builds patient confidence. As patients
experience progress—lifting heavier, performing more reps, or moving with less effort—they
become more engaged in their care and more motivated to stay consistent with home exercise
programs.
How Strength Training Benefits Common Rehab Populations
Post-Surgical Rehabilitation
Surgical procedures often require immobilization or reduced activity for a period of time. This
leads to rapid loss of muscle mass, strength, and coordination.
Strength training:
- Restores normal joint mechanics
- Prevents compensatory movement patterns
- Helps patients return to daily function or sport
For example, in ACL reconstruction rehabilitation, restoring quadriceps strength is crucial.
Studies show that quadriceps symmetry between limbs is one of the best predictors of a safe
return to sports.
Chronic Pain Management
Many patients with chronic pain—whether it's low back pain, fibromyalgia, or joint
pain—develop movement avoidance behaviors. However, inactivity leads to further weakness
and poor movement patterns, which can reinforce the pain cycle.
When introduced gradually and appropriately, resistance training:
- Enhances movement confidence
- Reduces pain sensitivity through nervous system adaptations
- Rebuilds strength and coordination in a safe and structured way
Older Adults
As people age, they naturally lose muscle mass (sarcopenia) and bone density, making daily
activities more difficult and increasing the risk of falls. Resistance training in older adults can:
- Improve balance and functional strength
- Prevent frailty and dependence
- Increase bone mineral density to reduce fracture risk
Physical therapists tailor programs using bodyweight, resistance bands, or light weights,
progressively building strength without overloading joints or causing strain.
Athletes Returning from Injury
Athletes, even at the highest level, often return to their sport with hidden strength deficits or poor
movement mechanics after injury. These deficits can increase the risk of reinjury.
Strength-focused rehabilitation ensures:
- Objective readiness for return to sport
- Muscle balance and movement efficiency
- Re-training of strength and power specific to the demands of their sport
What Strength Training Looks Like in Physical Therapy
Physical therapy-based resistance training is evidence-based, individualized, and safely
progressed. It is not a one-size-fits-all gym routine. Instead, therapists design programs based on
specific patient needs, injury types, and functional goals.
Key principles include:
Progressive Overload: Muscles must be progressively challenged to grow stronger. This can
involve increasing resistance, repetitions, sets, or time under tension.
Specificity: Exercises target muscle groups and movement patterns relevant to the patient’s
goals—whether that’s walking, lifting a grandchild, dunking, swinging, or sprinting
Quality Over Quantity: Therapists focus on proper form, intentional tempo, and movement
awareness. High-quality reps matter more than high volume.
Recovery: Muscles need time to recover and adapt. Most patients benefit from 2–4 strengthening
sessions per week, depending on their stage of healing and tolerance. These sessions should be
focused, not just flopping around for an hour with an aide or assistant
Debunking Common Myths
“I’m too old to lift weights.”
In reality, resistance training becomes more important as we age. It maintains mobility,
independence, and reduces fall risk.
“Lifting weights will make my pain worse.”
When properly dosed and progressed, strength training is one of the most effective tools for
reducing musculoskeletal pain.
“I only need to stretch, not strengthen.”
While flexibility has a role, most functional issues stem from strength and motor control deficits.
Stretching alone rarely addresses the root problem.
The Role of the Physical Therapist
What makes strength training in physical therapy different from general fitness training is the
level of clinical expertise behind it.
Physical therapists assess:
- Joint mobility and movement patterns
- Muscle strength and endurance
- Neuromuscular control
- Load tolerance
Functional goals
Using this information, we design personalized programs that allow you to progress, not just
train around or through injury, ensuring that each patient achieves optimal function.
Conclusion: Strength Is Foundational
In physical therapy, strength is not just a desirable quality—it’s the foundation for recovery,
performance, and long-term health.
Whether you’re overcoming injury, managing pain, aging actively, or striving to return to sport,
resistance training is a cornerstone of effective rehabilitation. It empowers patients to take
control of their recovery, build resilience, and confidently return to the activities they care about.
If you’re currently in physical therapy and strength training hasn’t been a part of your program, it
may be time to ask your provider. And if you’re a provider, remember that even the most passive
modality can't compete with the long-term impact of progressive resistance training.
Strength isn’t just for athletes. It’s for everyone. At OSO physical therapy it’s the key to moving
better, feeling better, and staying healthy
Dan Hirai
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