Nothing stops you from living your best life more than chronic aches and pains. Today, I’m talking about the hidden causes of most aches and pains, how to fix them, and the best strength training tips to reduce pain without making it worse. 

I explain why rehabilitating your joints through strength training is the best long-term solution to be pain-free. The trick is to stick with your strength training program but to slow it down. I review a study that shows how strength exercises reduce pain and improve function more effectively than other methods. When building a training program, it’s so important to focus on quadriceps, hamstrings, and glutes. Don’t forget that progression must be super gradual when chronic pain is involved, however not avoided!

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Topics covered

• The surprising connection between muscle weakness and pain
• How strength training helps improve runner’s knee
• Why most people focus on relief instead of prevention (and how that keeps you stuck)
• The #1 strength training consideration to reduce pain without making it worse
• My simple plan to start feeling stronger, healthier, and pain-free

Resources Mentioned

• Research on resistance exercise for knee osteoarthritis HERE
• Research on resistance training in musculoskeletal rehabilitation HERE
• Research on trunk, hip, and knee exercise programs HERE
• Research comparing two periodized exercise programs HERE
• Research on the epidemiology of weight-training sports injuries HERE
• Research on exercise for chronic pain HERE
• Research on knee crepitus HERE
• Transcripts can be found on the official blog page for this episode at hollyperkins.com/blog

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Workshop Promo!

Holly Perkins 0:00

If you've ever suffered from aches and pains or any kind of chronic discomfort, you know how much it colors your life. Physical pain of any kind is truly stressful, and it makes it a lot harder to be happy, let alone get through the day. There are many shades of pain, but this hidden cause is usually overlooked, and it's often the solution. If you want to learn how I help my clients eliminate pain forever, keep listening. Hello and welcome. I am so glad that you're here. If you are new, hello, I'm Holly Perkins, and I am obsessed with helping women feel better now and create the strong and resilient architecture you need to actually enjoy your years ahead. And when you do that, the added bonus is that you love how you look in your favorite jeans. Nothing keeps you from living your best life more than pain, whether that's subtle aches and pains or outright chronic and distracting pain.

Holly Perkins 1:18

After coaching women for 30 years, I know that about 70% of women have some kind of issue that bothers them on the regular. For me, it was bilateral knee pain, which was excruciating. Then, when I didn't fix the cause of that, it became sciatica, and then it became really annoying hip pain. At that point, I had had enough, and I committed to fixing myself without interventions like shots or surgery. It took a while, but I learned a lot, and it was worth it because now I am 100% pain-free and pretty much bulletproof. I got here by learning how to use strength training to realign and redesign my joints and, therefore, relieve the pain.

So, in a moment, I'm going to reveal the hidden cause of most typical aches and pains, and you'll get some tips on what to do so you can fix it. Before I do that, you might find that my upcoming free workshop is the answer to your prayers. So let me tell you a little bit about it.

Holly Perkins 2:36

Chronic pain is frustrating, exhausting, and sometimes even life-changing—and not in a good way. Obviously, if you've been dealing with persistent back pain, joint discomfort—either in your knees, hips, or back—or body aches that just won't go away despite stretching, therapy, or even maybe emotional work, you might be surprised to learn the hidden cause is often weak muscles that are failing to hold your bones in the right alignment at key joints. You might simply be missing one key element: strength training.

In this episode, you'll learn the real reasons why chronic pain lingers and why so few treatments actually work. You're going to hear the surprising connection between muscle weakness and pain, why most people focus on relief instead of prevention, and how that keeps you stuck.

Holly Perkins 3:43

The number one strength training consideration to reduce pain without making it worse, and a simple plan to start feeling stronger, healthier, and pain-free. Just this past year, one of my clients came to me with debilitating back pain that had plagued her for years and years. I think it was around 10 years after a diagnosis of degenerative disc disease. Say that three times! She proceeded to get shots in her back to alleviate the pain, and when that didn't work, she came to me. Within five months, she was pain-free. She had gained two pounds of muscle and was deadlifting like a boss.

Holly Perkins 4:29

Oh, and by the way, she was 57. Now, after 11 months, she has gained a total of 6.1 pounds of muscle, lost 20.4 pounds of pure fat—not body weight, fat—according to a DEXA scan, and she's progressing on all of her strength exercises, including Bulgarian split squats, walking lunges, and traditional squats. She's been pain-free for nearly a year. I say this to say: if you're in pain, there is a solution.

Holly Perkins 5:39

Now, if you've got patellofemoral pain, you know what I'm talking about. Sometimes it's called patellofemoral syndrome; sometimes it's called runner's knee. If you have it, you know it. If you haven't had it, basically what it is—it’s an irritation of the backside of the patella. And let me tell you, it's excruciating. Your knee feels like it is on fire.

A study published in the Journal of Strength and Conditioning Research found that periodized resistance training can be applied to those with CLBP, which is basically non-specific chronic low back pain, and it can be applied as a safe and effective form of rehabilitation. It's the same periodized training framework that is applied to a healthy or even athletic population, but with one exception—the program is more gradual in nature. Same exercises, same framework, same methodology—you just go about it more gradually.

Holly Perkins 6:42

The periodized resistance training program in this present study demonstrated substantial increases in muscular strength, endurance, flexibility, and power. The improvements in musculoskeletal health translated into reduced pain, reduced disability, and an overall improved quality of life. The data suggests three important points for rehabilitating CLBP, which is chronic low back pain:

Use a periodized training program. That's what I talk about all the time.

Exercise a large proportion of the musculoskeletal system. Basically, don’t just focus on back exercises if you have back pain, or just quad exercises if you have knee pain. You’ve got to strengthen the entire muscular system.

Use a combination of resistance methods. This means some body weight, some bands, some dumbbells, some machines—so that you're not only using, let's say, resistance bands, or only your body weight.

Holly Perkins 8:04

Do you want to hear the biggest mistake I see when women are in pain? Avoiding strength exercises because you believe it's going to make things worse.

Listen, as someone who was in so much pain—so much pain that I could not sit through a whole movie—trust me when I say I get it. I was tortured for a number of years in my 20s and 30s until I finally got it. Truly, when you are in pain, it can be scary, and it doesn’t help that many uneducated doctors actually tell their clients not to exercise. “Don’t squat or deadlift so you can, quote-unquote, protect your back or your knees.” But listen closely—protecting your knees is what's causing the problem. When you avoid certain activities or movements, you are further weakening the muscles around the knee joint that direct the joint into optimal alignment.

Holly Perkins 9:01

And listen, this applies no matter what your pain is—whether it’s neck pain, shoulder pain, ankle pain—this concept applies to any of these run-of-the-mill general aches and pains, and yes, outright chronic pain. The same goes for your hips or your back.

A little anatomy lesson here: antagonistic muscle groups control your joints, and they work in opposition to each other to control movement. They provide stability and prevent injury. Depending on the direction of the action at the joint—whether it’s knee extension or knee flexion—different muscles are considered the agonist, the one in charge.

For example, if you're extending your knee, meaning you're straightening your knee, your quadricep is the agonist. But if you're bending your knee, like a runner, the agonist is the hamstring. If one muscle is weak, the other muscle tends to become more dominant, causing an imbalance at the joint. Over time, this can cause subtle aches and pains—or even outright pain and trouble.

This is vastus medialis oblique. I love this muscle, and we often see a weakness there, which causes improper movement, really, of the patella when you extend your lower leg. In my practice, I often see that women have weak hamstrings, the opposing muscle group. Either way, the solution here is that each of these major muscle groups needs to be strengthened relative to each other. And while I am a huge proponent of seeking out the support of a physical therapist, this is also a problem I see in the physical therapy industry because it's so laser-focused on the area.

For example, one of the common treatments for patellofemoral syndrome is to strengthen what I just talked about—the quadriceps. And so we do leg extensions with that, and that's great. It strengthens the quadriceps. But if you don't move into what's called phase three of physical therapy, you're not also strengthening the hamstrings in proportion so that you've got proper function of the entire joint through all movement patterns. And this is exactly why I spend so much time, I labor, when I create strength training programming. Whether it's for one-on-one clients or in my programs, I really pride myself on my programming because there needs to be the right volume of exercises for each muscle group, and you also need the right movement patterns for different muscle groups.

So you need a certain amount of hip extension versus hip abduction, rotation, and flexion. The various muscle groups really need to be strengthened in a proportionate way. Too many quad-dominant exercises cause quad dominance, which is where the quads are stronger relative to your hamstrings. And I see this in women all the time, and this ends up further weakening the already weak hamstrings. After 30 years in practice working with women in the gym, I have never met a woman whose hamstrings were dominant. Never. I've also never met a woman whose glutes were up to par, and these two muscle groups impact so much about how your lower body moves, how your hips stabilize, and how the knee joint functions.

So the takeaway here is weak muscles cause imbalances at the related joint, and this usually leads to dysfunction and pain—often at that joint, but sometimes it can actually cause pain or dysfunction at a different joint further up the kinetic chain. So when I didn't fix the problem at my knee, it became hip pain. Even though the real issue was at my knee—I had weak hamstrings—the pain was at my hip. The other takeaway here is that the right strength training program can create balance around your joints and reduce or eliminate problems at the hip, knee, and back. You've got to be strength training consistently to reduce aches and pains.

And here's the thing: if you don't fix this now, imagine what your days or your life will be like in five or 10 years if you continue as you are. When you use a well-designed strength plan like one of mine, you'll be on the path to becoming stronger. The worst thing to do is nothing. If you're in pain, it makes sense that you're looking for relief. It's an evolutionary response to prioritize getting out of pain. It's like you're laser-focused on, "How do I get out of pain?"

Understandable. I believe this is why so many doctors push painkillers and surgery. And you know, I would even rephrase that and say a lot of patients are coming in begging for a fast solution, and therefore the doctors are providing it in the form of fast solutions. It's the fastest way to get a patient out of pain—by giving them a painkiller or recommending surgery. The problem is that both of them are rarely effective. So if this episode speaks to you and you've been struggling with some kind of pain for a long time, I encourage you to look back over your history and think: Did a doctor recommend surgery, and now, 10 years later, you're in pain again? Or was there some protocol that was recommended that worked for a minute and then it didn't? Or it just didn't work at all?

Did you know that the long-term success rates of surgery for chronic pain are actually really low? Now listen, I'm not talking about surgery that's needed following an acute or traumatic injury. I'm not talking about that here. If you break a bone or get in a car accident and you have to have corrective surgery, that's something different. I'm really talking about things like chronic hip, knee, back pain, shoulder, and neck pain. Okay? Years ago, a study came out that was very well designed, and it looked at people with patellofemoral syndrome knee pain who were opting for arthroscopic surgery, which is very common for this syndrome. The double-blind study put people into two groups.

Both groups would undergo an arthroscopic surgery procedure, but only one group would actually have the corrective procedure. And this was double-blind, so both the doctors and the participants didn't know what was going to happen when they were rolled into the surgery room. In the group who didn't actually have the surgery, they even created an incision so that after the surgery, both groups would have no idea if they actually had the procedure done or not.

So the study tracked the two groups for a long time after that. I forget exactly how long it was, but they found that there was zero correlation between symptoms and procedure. This means that some people in the group that didn't get the procedure at all reported that they had relief and they did not have knee pain again. And some people in the group who actually had the procedure didn't experience relief. Now, if I remember correctly, a comment or sort of a conclusion, if you will, of that study is that there's probably also some level of psychological or emotional connection here. Belief is a very profound thing, and it also really comments on, as I said, the success rates of surgery when we track people over a long period of time.

The moral of the story here is: 99.9% of the time, rehabbing your joints through strength training is a permanent solution that you can actually control. If you're able to, I encourage you to listen to your pain. Get into a conversation with it rather than finding relief or seeking relief through some quick solution. Instead, work with it over time. This is what I did. I developed a relationship with my pain, and over time, strengthened my muscles so that the joint begins to fall into better alignment.

Now, listen, it's a process. You're not going to start a strength training program and in two weeks, four weeks, or even six weeks be completely pain-free. It doesn't work that way. This approach is long-term, and it's not pain relief-focused in the short term. As I mentioned earlier when referencing one of the studies, the only difference in protocol if you're in pain is to progress a bit more slowly. It still should be a well-designed, whole-body strengthening program. You just progress a little bit more conservatively than someone who's not in pain. And if you can do that, you'll notice each week your pain will subside until one day you wake up and realize you haven't even felt that pain for days, weeks, or maybe even months.

So let me give you just a little bit of actual how-to here. Number one: for knee pain, you'll want to focus on strengthening the quadriceps—that's the front of your thighs—hamstrings, the back of your thighs, and what's called glute medius. It's one of your glute muscles and the smallest of the glute muscles. Some specific exercises are leg extensions. I love leg extensions for knee issues, and it's maybe a bit controversial in my field. Some people feel it can be irritating. Again, if you learn the right technique, start with a light weight load, and progress very gradually over time, it makes a huge difference. This is one of the ways that I rehabbed my knees.

Leg extension is one of my favorite exercises for strengthening the vastus medialis oblique (VMO). That is the quadricep muscle that controls the tracking of your patella. I also love a seated leg curl. This is a little different than the prone leg curl where you lay down on your tummy and pull your heels up to your hips. Instead, you sit and pull your heels from a straight-leg position under you so that your heels move toward your butt. Lastly, I love side-lying abduction with an ankle weight.

It’s funny because this is one of those exercises we call a "Jane Fonda" exercise from the '80s, but it is one of the best exercises for glute medius and stabilizing your hips. And, oh yes, I did just say hips and glutes, because there is a huge correlation—if not the whole reason—between knee pain and glutes, even more so than quadriceps and hamstrings. I believe, and I don't think I'm the only one in my field that believes this, that it all tracks back to your glutes. If your glutes are weak, and more specifically your glute medius, there is a change in the angle of the femur, which is your thigh bone, and that changes how the knee tracks.

So I would actually argue that fixing your knee is really about fixing your glutes. Number two: for back pain, this one is tricky because back pain is tricky. But the answer usually lies in learning how to hip hinge correctly. You know how when you bend over to pick something up, unload the dishwasher, or wash your face at the sink, if you're not thinking about it, you might round out at your lower back? Yeah, don't do that. When you bend over, you should be moving your hips back in space into what we call a hip hinge.

This means that your lower back is going to maintain a neutral curvature. It won’t round out; it will keep its neutral curvature. It takes time to learn to do this correctly, but it has worked every single time for me and my clients. In fact, some of my family members make fun of me because when I unload the dishwasher, I stick my butt back—almost like a booty pop—but it feels so good, and it really improves the strength of your lower back. Here are some particular exercises you can experiment with depending on how much back pain you have.

Again, remember, this is general back pain, not pain from an outright diagnosed injury. Romanian deadlifts, either with a barbell or dumbbells, are great. Single-leg deadlifts are probably an exercise that appears in almost every single program I create because it's such a powerful exercise. I really believe every single woman should be doing it. It improves balance, but also really strengthens the glute medius. A traditional back squat, where you ensure that your technique is good, is also essential.

If you're going to do a back squat, it's really important that you work on your technique long before you start to go heavier. Number three: for hip pain—which is my favorite! I'm obsessed with the hips—it’s almost always, and I think I can safely say always, caused by weak glutes. Weak glutes mean they are not holding your pelvis at the proper angle, which is about 10 to 15 degrees when standing. The solution is to strengthen all of the glutes, with an emphasis on the glute medius and hamstrings, so these muscles pull back and down on your pelvis to lock you into the ideal rotation. My favorite exercises here are cable kickbacks, glute bridges on the floor, hip thrusts with your shoulders elevated, hip extensions with an ankle weight, and lateral band stepping.

The number one strength training consideration to reduce pain without making it worse is to start slowly and progress gradually so that you can assess yourself daily or every other day. This means starting with weight loads that are actually lighter than you think you can handle. For some of these exercises, I've even had generally fit and healthy clients start with one pound, believe it or not.

When remedying pain, it's helpful to start light so that you activate the muscle without compensating, allowing for proper strengthening while focusing on perfect technique. The right technique activates the intended muscles for each specific exercise. It's important to get laser-focused on learning the right technique and nuances for each exercise to improve your pain.

As weak muscles get stronger, they'll cause a change in the mobility and flexibility of the joint. As your hamstrings get stronger, they’ll change the mobility of the knee joint and, therefore, the flexibility of your quadriceps. If you have knee pain, you probably have tight quads. Even though you have tight quads, that doesn’t mean they’re strong. Even if you have quad dominance, you can still have weaknesses in your quadriceps because there are four quadricep muscles. That’s why they’re called the quads. In particular, it could be related to the vastus medialis oblique (VMO) that I mentioned earlier.

Give your body time to adjust and recover, as the opposing muscle groups are adapting as well. A great rep scheme I use with clients when redesigning a joint and working through pain is:

Find your starting weight load for key exercises.

Choose a light weight that allows you to perform two to three sets of 10 reps with perfect technique but still provides a challenge.

After two weeks, increase to 12 reps.

After another two weeks, increase to 15 reps.

After two more weeks, increase the weight and reduce reps back to 10, restarting the process at the new weight.

This approach works miracles. It takes patience, but it works. In summary, the hidden cause of chronic pain is muscle weakness and dysfunction. The best way to fix it is through serious strength training. You can rehabilitate any joint if you stay focused, determined, and patient.

I hope you enjoyed this episode! Don’t forget to register for my free workshop, Mastering Your Body Composition. Visit hollyperkins.com/freeworkshop to sign up. See you next Tuesday for another episode. Stay strong, stay you!