Opinion It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief, 2026, Powell et al

The editorial is pay-walled and does not have an abstract, but this Globe & Mail article summarizes its content: The real reason strength training helps reduce pain and rehab injuries. In short: the woo is spreading everywhere, medicine is relying more and more on faith and beliefs to fill in the gaps in what they can do.

A recent meta-analysis, which pooled results from 12 studies, did indeed find that exercise reduced pain and improved physical function in people with knee osteoarthritis. But the benefits didn’t depend on how much stronger the patients got. In fact, increased strength explained just two per cent of the observed improvements.

“It’s not nothing,” says Jared Powell, a physiotherapist at Bond University in Australia and the lead author of the new study, “but it certainly doesn’t seem to be the dominant mechanism of improvement.”
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(Thread on the meta-analysis here: https://www.s4me.info/threads/mecha...ipd-mediation-study-2023-runhaar-et-al.49686/).
A well-planned and gradual exercise routine might also help people lose the fear of movement – what clinicians call kinesiophobia – which can set in after a prolonged period of pain or injury. And it can reduce pain catastrophizing, which is the fear that minor discomfort will inevitably spiral into more serious pain if you keep moving the affected joint or limb.
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These latter explanations are harder to measure or quantify, but they reflect a growing belief among doctors and scientists that our experiences of pain depend not just on signals generated by our bodies, but also on how those signals are interpreted in our brains. And they suggest that the exact details of the rehab program you follow may not be as important as previously thought.

“The context in which exercise is delivered is probably just as important as the exercise itself,” Powell says. “A clinician who builds trust, validates the patient’s experience, and helps them reconnect with activities they value is probably doing more than any particular set-and-rep scheme.”
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But acknowledging that building strength isn’t the only goal of a rehab program has a crucial benefit: It means that your pain might improve even if you don’t seem to be getting stronger as quickly as you hoped. And it gives you some flexibility to tailor your exercise program to your own interests and goals.
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This last one is the crux of it: "you might not see any benefits, but there are benefits, they are subjective, you just can't perceive them, and we can't observe them, or measure them, or even assess them, but we believe in them and so must you".

Losing the plot more and more each year. This whole ideology has completely crashed out, failed every single test it has been put through, and it's more popular than ever.
 
I wonder how much money that could be saved if we replaced the rehabbers and their centres with nurses that are kind to you. You might need a few places for the equipment heavy reconvalescence processes and patients that are care dependent.

Spend some of the savings on cakes and chocolates to improve the mood, I bet you’d get even better scores on the PROS..
 
The amount of physio I had for a knee giving way was huge.
I busted my knee playing football, with a round ball.;)
It took ortho's 8 years to find the culprits, meniscus and ACL were taken out.

Knesiofobia? Hell no, I kept playing volleyball.

Knee still giving way, physio, physio and more physio. I lifted 80 kg, the whole iron structure and the therapist sitting on that structure, 200 kg.
Arthroscopy, nothing found, new ACL was an option. Untill the knee was opened, oeps, a bone bridge had formed by the old ACL tearing a piece of bone off that kept growing. 2 arthro's, 4 orthopeads and 14 years of which I played volleyball for 10 years.
Catastrophizing pain? Send me the physio's, ortho's and psycho's (this time no spelling mistake) using that ghastly construct and I'll give them a lecture they will never forget.
 
I can't help but think that there is some "folksy" thing going on here, a preference for treating people with gentle hands and advice being seen as superior, more "natural", than with drugs or surgical instruments.

All very similar to all other woo ideologies. This undying idea that "natural" things are better, no matter how much that definition of natural veers into magical.
 
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