Patients frequently ask about changes they have noticed in muscle strength and size.

Whenever we develop a problem, we immediately carry out a detailed inspection and take a look at the offending area.

• Were those knobbly bits there before?
• Does it look a bit different to the same area on the other side?
• Is it a bit ’puffy’?

We notice that the muscle is less bulky around the problem area. The assumption then is that this reduced muscle mass and subsequent weakness is the cause of the problem.

The obvious step is to set about correcting this problem with a set of strengthening exercises. Unfortunately, this rarely results in the outcome we are striving to achieve.

Firstly, it may well be a red herring. Our bodies are generally quite asymmetrical and this normal ‘wonkiness’ is of little consequence. However, we normally only notice this during the pain induced inspection, and so the tendency is to jump to the conclusion that this has been the cause of the problem all along.

Secondly, more marked differences in muscle bulk are likely to be as a result of the pain rather than being the cause of the pain itself.

Pain causes reflex muscle inhibition, so if an area has been painful for long enough, you will see a reduction in muscle mass resulting in weakness. This may than exacerbate the problem still further.

Whilst the pain persists, strength exercises will remain ineffective. You are turning the muscles on, the pain is turning them off.

Fortunately, physiotherapy treatment can help to treat the cause of the pain, following which, carefully graded strengthening exercises will see the muscle restored to it’s former shape and strength.