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If a muscle is weak, does that mean we're more likely to have pain?

For example...

Do weak hip flexors cause hip pain?
Does a weak core cause back pain?
Do weak glutes cause knee pain?

It's common to hear pain blamed on weak muscles. But in general, muscle weakness is not a sole factor for any pain or pathology.

This is because all pains and pathologies are multifactorial, and blaming them on one factor such as weakness is a reductionist approach that the evidence doesn't support.

The same goes for the common practice of blaming one's pain on their age.

It's not that simple! There are people at one's same age and older who don’t have these same aches and pains. So it can't simply boil down to age as a sole factor.

Additionally, if you take a step back and think about it, you’ll realize that people who are strong and people who are weak both experience pain! Pain clearly isn’t an experience that’s isolated to those with weak muscles.

So we really can’t blame any single factor like one’s age or weak muscles for pain. Pain is always a multifactorial phenomenon.

Now on the flip side of this question, we do know that strength exercises can often be helpful for pain.

But the specific reason they're helpful is probably more complex than the fact that they improve one's ability to produce force (i.e., they make them less weak).

Think about it: there's so much more going on when we strength train than simply *strengthening*.

For example, strength work can positively affect systemic chronic inflammation, which may improve how someone feels.

Strength training can also increase confidence and trust in the robustness of one's body, which can reduce pain perception.

There are an abundance of possible mechanisms by which strength work could help with pain, and specifically reducing weakness is just one possibility.

However, this doesn't mean that weakness has no role to play in people's problems!

In the big picture, a sedentary lifestyle and a lack of physical activity can contribute to a condition called sarcopenia, or muscle mass loss (especially as we age).

Sarcopenia is associated with functional decline and loss of independence as one ages, as well as frailty and other adverse health outcomes.

In this sense, weakness can be associated with pain and pathology, but in a bigger picture way than people generally mean when they declare that "you have back pain because your core is weak."

As always, the human body is complex, and simple, black-and-white approaches to pain are generally not the evidence-based answer.