It has been understood for a long time that movement and strength training are the most effective forms of treatment and essential components in the rehabilitation of patients across a broad range of conditions.
From post-surgical recovery to managing chronic diseases and neurological conditions, evidence consistently highlights the significance of these interventions. Yet, for many patients, the power of movement and strength training can be overlooked in favour of attempts to find quick fixes, including passive treatments like manual therapies.
I myself used to be a massage therapist and personal trainer. Prior to studying and reading the scientific evidence throughout my physio degree, I had already started to reach the conclusion that strength and movement were far superior for my clients to get results. Sure massage can provide immediate pain relief and is useful for acute conditions where the muscles are in spasm but beyond that there is limited evidence to it’s benefits. Physiotherapy training used to include manual techniques but in recent years these have dropped off the curriculum due to the lack of supporting evidence to their efficacy.
This blog aims to explore why movement and strength training are vital in physiotherapy, separating evidence-based practices from misconceptions, and highlighting on how these foundational interventions help improve quality of life and long-term health outcomes.
The Role of Physiotherapy in Restoring Function
Physiotherapists play a critical role in restoring movement, reducing pain, and improving quality of life. With the ever-expanding knowledge base within healthcare, physiotherapy has evolved beyond symptom management to encompass holistic, patient-centered care. Within this model which we call the biopsychosocial model, treatment is often focused on restoring function through active engagement rather than relying purely on passive therapies.
As a physiotherapist, I have seen first hand the impact of evidence-based interventions, and this is the key point here; there is a body of evidence that far outweighs other modalities such as chiropractic and other passive therapies. Movement and strength training, especially when treating complex conditions, including those with neurological impairments have proven high quality studies published. While each patient presents unique challenges, one truth remains clear: movement is medicine.
The Science Behind Movement: More Than Just Exercise
It is important to clarify that when physiotherapists prescribe movement and strength training, it is not simply “exercise” in a generic sense. These interventions are specifically tailored to address the individual’s physical deficits and therapeutic needs. The importance of movement in rehabilitation is rooted in several physiological mechanisms:
- Neuromuscular Re-education: For many patients, especially those with neurological conditions, such as stroke or traumatic brain injury (TBI), movement retraining is essential. These patients need to re-learn how to perform tasks that were once second nature. Research shows that consistent, targeted movement training can promote neural plasticity, helping the brain to rewire and restore function.
- Restoring Joint Mobility and Muscle Flexibility: Conditions such as osteoarthritis or post-operative recovery often lead to joint stiffness and decreased flexibility. Movement-based interventions can help reduce and prevent the development of contractures or fibrous adhesions that can further impair movement.
- Strengthening Key Muscle Groups: Strength is critical in nearly all aspects of movement, from maintaining balance and coordination to preventing falls. For patients with muscle atrophy (wasting) or weakness following injury or surgery, strength training is essential to restoring normal function.
Evidence-Based Approach: The Role of Strength Training
Strength Training and Musculoskeletal Rehabilitation
Patients recovering from musculoskeletal injuries, fractures, or surgeries, benefit immensely from progressive resistance exercises. In cases like anterior cruciate ligament (ACL) reconstruction or rotator cuff injuries, strength training not only improves functional outcomes but also reduces the risk of re-injury.
Neurological Conditions: A Case for Strength
For individuals with neurological disorders such as stroke, spinal cord injury, or multiple sclerosis, muscle weakness can be profound. Strength training, when appropriately prescribed, has been shown to improve mobility, balance, and even walking speed. In particular, strength training in patients recovering from stroke has been demonstrated to reduce muscle weakness, thereby enhancing the performance of daily activities.
The biopsychosocial model, which is at the heart of effective physiotherapy, recognises that addressing the physical symptoms of a condition alone is insufficient. Movement and strength training interventions have been shown to have profound psychological benefits, including reducing depression and anxiety in patients recovering from chronic pain or neurological trauma.
Dispelling Myths: Why Movement and Strength Training Should Be Prioritised Over Passive Therapies
For many patients, the allure of passive therapies such as manual manipulation, electrotherapy, or ultrasound treatments can seem attractive. These therapies, often referred to as “quick fixes,” offer immediate relief or relaxation, but they do little to address the underlying causes of dysfunction. Moreover, they do not empower the patient to take an active role in their recovery, which is essential for long-term success.
One particularly misunderstood therapy is the so-called “back cracking” or spinal manipulation. While it is true that chiropractic manipulation may offer temporary relief in some cases, it is not a substitute for the longer-term benefits of movement and strength training. In fact, the evidence supporting movement and strength training far outweighs that of passive manipulation when it comes to sustained recovery and functional improvement.
Patient Empowerment Through Movement
As a physiotherapist, I have seen how passive therapies can sometimes create a false sense of progress. The temporary relief offered by such treatments does not equate to true recovery. Active therapies, by contrast, encourage patients to participate in their own rehabilitation. This involvement is key not only for physical recovery but also for building confidence and psychological resilience.
Patients recovering from serious conditions like stroke or spinal cord injury, for example, often face a long road to recovery. While movement and strength training may seem daunting at first, these interventions are vital for regaining independence. It is through gradual, targeted movement that patients rebuild neural pathways and muscular strength, eventually overcoming functional limitations.
Personalised Treatment Plans: The Role of the Physiotherapist
The success of movement and strength training in physiotherapy is grounded in the individualized approach taken by practitioners. Physiotherapists develop tailored treatment plans based on a comprehensive assessment of the patient’s physical, psychological, and social needs.
Assessment and Outcome Measures
By setting specific, measurable goals in collaboration with the patient, we create a roadmap for recovery. Movement-based interventions are adjusted as the patient progresses, ensuring that the rehabilitation process is dynamic and responsive to their changing needs.
Addressing Complex Co-morbidities
In my experience, particularly with neurological patients, there is often a complex range of co-morbidities to address. These patients may present with a combination of muscular weakness, spasticity, balance issues, and pain. It is not uncommon for patients to disengage from therapy due to the overwhelming nature of their condition. In these cases, movement and strength training must be introduced gradually, with a focus on building confidence and setting achievable milestones.
As a practitioner committed to continuous learning, I have seen how small changes in movement patterns, even in highly disengaged patients, can lead to significant progress over time. One example is a patient who initially presented as bed-bound but, through consistent movement training, progressed to walking independently. This type of transformation is evidence of the profound impact that active interventions can have on patients’ lives.
The Biopsychosocial Model: A Holistic Approach to Patient Care
Movement and strength training are central to the biopsychosocial model, which emphasises the importance of addressing the physical, psychological, and social aspects of patient care. This model recognises that physical recovery is only one piece of the puzzle.
Psychological Benefits of Movement
Physiotherapists often work with patients who are experiencing not only physical but also emotional and psychological challenges. Whether it’s the frustration of a slow recovery or the anxiety of dealing with chronic pain, these psychological factors can hinder progress.
Movement and strength training have been shown to reduce stress, anxiety, and depression, particularly in patients with chronic pain or neurological conditions. Engaging in regular physical activity releases endorphins and promotes a sense of accomplishment, helping to improve the patient’s overall outlook on recovery.
Social Factors and Patient Engagement
The social aspect of rehabilitation is often overlooked but is equally important in patient outcomes. Many patients, particularly those with neurological conditions, may experience isolation or social withdrawal due to their physical limitations. Movement-based interventions provide an opportunity for social interaction, whether through group physiotherapy sessions or family involvement in therapy. This social support can be instrumental in motivating patients to stick with their treatment plan.
The Future of Physiotherapy: Movement and Strength at the Core
As physiotherapy continues to evolve, the emphasis on movement and strength training is only set to grow. Advances in technology, such as virtual rehabilitation and wearable devices, will allow for even more personalized and data-driven approaches to movement therapy. These innovations will provide real-time feedback on patient performance, further enhancing the effectiveness of strength and movement-based interventions.
Moreover, the integration of research and evidence-based practice will continue to shape physiotherapy, and based on current evidence it is likely that movement and strength training will remain central to treatment protocols. With ongoing training and professional development, physiotherapists will be equipped to deliver the most effective care, grounded in the latest scientific evidence.
Conclusion: Why Movement and Strength Training Prevail
The evidence is clear: movement and strength training are essential components of physiotherapy that deliver sustained benefits across a wide range of conditions. From musculoskeletal injuries to complex neurological impairments, these interventions are key to restoring function, improving quality of life, and empowering patients to take an active role in their recovery.
As we move forward in the field of physiotherapy, it is crucial that we continue to prioritise active, evidence-based interventions. By doing so, we can ensure that patients receive the best possible care, grounded in the understanding that movement truly is medicine.