“If we strengthen your hips, your back pain will go away.”
This phrase — or some iteration of it — is spoken on a daily occurrence in most physical therapy practices across the country. Unfortunately, research doesn't support it.
The relationship between hip strength and hip pain
It is common to assess strength during a physical therapy evaluation. Strength can be used to assess resilience and the ability to perform high-intensity tasks, such as running or lifting something heavy. There is no question that strength is useful, the question is whether strength influences our pain experiences.
A 2018 study recruited people with hip pain. Each participant completed a series of questionnaires that assessed psychosocial factors that influence pain. These included pain catastrophizing, depression, pain self-efficacy, and quality of life. The participants also reported their activity and pain levels. Lastly, the researchers measure waist girth, body mass index (BMI), muscle strength, and hip circumference.
After the assessments were performed, each participant received an MRI of the hip to look for gluteal tendinopathy — degeneration in a tendon that attached to the hip. After all of the participants were screened, 208 had confirmed gluteal tendinopathy and were included in the study.
The participants were separated into low, moderate, and severe pain groups. The aim of the study was to compare physical and psychological characteristics between subgroups of varying severity of pain and disability. They found higher pain catastrophizing (an exaggerated pain experience and the feeling of helplessness) and depression scores, lower pain self-efficacy scores (the ability to manage pain independently), greater waist girth and BMI, lower activity levels, and poorer quality of life in the severe pain group. Hip strength and hip circumference did not differ between subgroups of severity.
What does this mean?
Hip strength was likely no a factor in determining a participant's pain experience.
What do we do with this information?
This study does not mean strength is irrelevant in physical therapy and sports medicine, but it does call into question whether strength is related to the pain experience.
Strength may play a role in injury prevention, although it is just a piece of the puzzle. Pain is complex and research is clear that psychosocial factors must be assessed. They often play a larger role than physical factors, such as strength or injury.
Keep exercising to build strength and resilience, but understand other areas need to be addressed. If your physical therapist, orthopedist, or athletic trainer tells you getting strong will resolve your pain, mention this study and see what they think. The goal is not to humiliate or discredit them. The goal is to start a dialogue and promote shared decision-making.
We need more of that in healthcare.