It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief (bjsm.bmj.com)

• Strength gains are not the main driver of pain relief.
• Psychosocial factors mediate exercise-induced hypoalgesia.
• Clinicians should broaden outcome measures beyond strength.

"An editorial in the British Journal of Sports Medicine challenges the common assumption that strength gains are the primary driver of pain reduction in musculoskeletal rehabilitation, advocating for a broader biopsychosocial framework. It argues that evidence linking strength increases to pain relief is weak and that factors like pain cognition, self-efficacy, and contextual effects are more influential. Clinicians are urged to expand outcome measures beyond strength and incorporate patient education, fear reduction, and shared decision-making."