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Is pain causing your weakness? Or is weakness causing your pain?

This is one of the trickiest questions in rehab, sports med, and pain science. The short answer: often it's both, and they can feed each other in a loop. But there are ways we can tease apart which is leading the dance.

1. Pain → weakness Pain can inhibit muscles even if the muscle itself is healthy because:

• The nervous system down-regulates muscle activation to protect you

• You subconsciously avoid loading or using the area

• Pain changes movement patterns ("guarding") Clues this is happening:

• Weakness appeared after the pain started

• Strength improves when pain is reduced (e.g., after rest, meds, warm-up, or manual therapy)

• Muscle tests better when pain is minimized or distracted

• Imaging looks normal or mild

• Classic example: knee pain causing quad inhibition.

2. Weakness → pain Here, the tissue is overloaded because support isn't there. This happens when:

• A muscle isn't doing its share of work

• Other tissues compensate (tendons, joints, ligaments)

• Repetitive stress accumulates Clues this is happening:

• Weakness existed before pain

• Pain shows up with fatigue or repeated use

• Pain decreases as strength and control improve

• Pain is very task-specific (running, lifting, stairs, overhead work)

• Classic example: hip weakness contributing to knee or low-back pain.

The honest reality: In chronic or recurrent issues, pain causes weakness, weakness worsens pain, and the nervous system adapts to both. So treatment usually targets both at once:

• Reduce pain sensitivity

• Restore strength and confidence

• Re-teach normal movement

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Does your pelvic floor meet the barre?

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Where? Elite Nation Wellness 3821 Falmouth Road

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Play Longer, Hurt Less: Pickleball Injury Prevention

BRING YOUR BEST GAME TO THE COURT Join us for an interactive discussion including

• Most common pickleball injuries

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• Treatment options for common injuries.

• What can you play through vs

• What will keep you on the sideline.

Join Kara McKeown PT, MS Nicole Shirley PT, DPT and Special Guests Pickleball Pro and Instructors Diane & Brian King

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