Does Weakness Cause Pain?


Dr. Justin Sullivan, PT, OCS, CFMT

I LOVE strength. I actually have the word tattooed on me! I also love solving complex puzzles…and instant gratification. (Don’t we all??). I’ve worked within the Strength, Conditioning and Rehab realm for over two decades and have been taught and mentored by some of the best in the world.

It’s time to address an EXTREMELY popular notion that has plagued the world of Orthopedics, rehab and training world long enough. This notion suggests that if you have pain in a region, it is mainly caused by a lack of strength in that area.

This is simply NOT TRUE.

The concept that weakness creates pain comes from the results of a simple exam. For example: if you have knee pain and we test the strength of the muscles that surround your painful knee – they will almost definitely be weaker than the non-painful side…So, why do we (wrongly) conclude that weakness was the CAUSE of the pain, and not the reverse? Several reasons:

  1. If you exercise a painful area (in a way that isn’t painful), it reinforces “safety” to the brain. So the brain becomes less concerned about tissue damage to that area – so it’s less sensitive and can endure more punishment before you’re made aware.
  2. Exercise releases endorphins, which have (temporary) pain-reducing effects. Problems are still there, you just don’t feel it.
  3. Strengthening the muscles around any area will support and reinforce the tissues and motions (that are available) in that area.***

That last “reason” is a Trojan Horse. Let me explain, based on mounds of research and the thousands of complex cases that I’ve personally seen – who DIDN’T get better with typical approaches…

  1. Pain is Inhibitory (shuts things down) – if we introduce pain (threat of tissue damage) to a healthy area, the muscles become less responsive and can contract less. This is protective, so you don’t make things worse. By attempting to “strengthen” the area, we begin to override this protection.
  2. Pain isn’t your muscles’ fault – the basic purpose of a muscle is to create or stop movement. Repeated muscle tears are (very) often caused by overloading a muscle that is already doing too much…whether it’s because of compensation or protection of another (more important) structure – like an organ, nerve or blood vessel. By “strengthening” these muscles, we add to the workload, which may eventually lead to failure or tear of the muscle or tendon.
  3. Wearing down a tissue “__itis” (joint, bursa, tendon, etc) happens BECAUSE your movements are faulty and full of compensations (from previous injuries, habit patterns, etc). By strengthening these faulty motions, we SPEED UP the breakdown of the tissues.

FUN FACT: training a muscle to get stronger takes about 6 weeks for decent results.

FUN-ER FACT: If the REASON the muscles are inhibited (pain, tissue or organ dysfunction) is addressed – the muscles become INSTANTLY STRONGER. (THIS is what I spend my most of time on… and use my hands for – called “disinhibition”)

FUN-EST FACT: That increase in strength (disinhibition) doesn’t require much training, and the faulty movement patterns can be readily changed. This means your system is stronger, faster, more mobile – and needs less energy to do everything!


Rather than continuing (and speeding up) the cycle of breaking down tissues, get a painful area treated by asking a (good) clinician WHY it hurts. Don’t settle for the simplistic answers (weakness, age, arthritis, weight)…find a clinician that will consider ALL the factors, tissues, movements, systems, etc. *Hint- the problem is likely far away from the painful part…and often times is related to a different system of the body!

Remember: Addressing the ROOT cause of a problem yields INSTANT and long-term results…if you’re not seeing/feeling results every treatment, you should consider switching.

Good luck in your pursuits. We always can be a resource for you, so please feel free to reach out to us!


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