When it comes to physical therapy, not all experiences are created equal. At CAIRN, we've talked before about what physical therapy looks like—what to expect, what it includes — but today, I want to dig deeper into what actually leads to success in PT.

Whether you're dealing with stiffness, weakness, chronic pain, or recovering from injury, three key ingredients tend to determine your outcome:

1. Time

Success in physical therapy takes time. Most of the issues we treat—like muscle imbalances, joint restrictions, or chronic pain—develop over weeks, months, or even years. Reversing those changes won't happen overnight.
Research shows that it takes 6–9 weeks of consistent effort for measurable strength and endurance gains to appear. That's your body literally changing—building new tissue, improving oxygen use, adapting on a cellular level. If you're hoping for a quick fix, you may get discouraged. But with time and patience, your body can do amazing things.

2. A Solid Plan of Care

A good PT program is more than just exercises on a sheet. It starts with a proper physical therapy diagnosis—identifying what's tight, what's weak, what tissues are inflamed, and what stage of healing you're in.

From there, the plan should include:

• A prognosis: how long will it take to improve?
• Progressive programming: each session should build on the last, increasing challenge in intensity, complexity, or duration.
• Function-based goals: the program should help you return to the things you struggle with—whether that's walking stairs or getting out of bed.
• A transition strategy: many patients are discharged before their body is fully adapted. Continuing to progress beyond the clinic is crucial to long-term success.

3. An Involved Patient

The most important factor might just be you.

1. Be Consistent: Consistency — not perfection — is what drives change. Showing up and doing your home exercises regularly is key.
2. Be Participatory: It's not just about doing the exercises; it's about giving feedback. Tell your therapist what feels better or worse. Did something reduce your pain or increase it? That information is gold for adjusting your plan.

Be Open to Learning: Many of us hold beliefs about our bodies that aren't helpful—or even true. Maybe you think exercise will make your pain worse. Maybe you believe your body is too fragile to improve. But the truth is: your body is resilient. And belief matters—research shows that expecting improvement leads to better outcomes.

3. Be Willing to Work: Finally, progress requires effort. Especially in later stages of therapy, pushing hard enough to spark strength gains means working at 65% or more of your max. That's tough, but it's also what creates lasting change.

Final Thoughts

If you're navigating physical therapy—whether for a new injury or a long - standing issue — remember this: your outcome is shaped by time, a well-designed plan, and your own active involvement.

At CAIRN, we're here to guide you with progressive programming and individualized care. If you're ready to put in the work, we'll meet you there.

Have a question or topic you'd like us to cover on the podcast or blog?

Email us at info@cairnstrength.com

As healthcare providers, we're trusted to offer guidance rooted in best practices and current evidence. But here's the thing - healthcare isn't static. What was considered best practice when I started in 2008 isn't necessarily how we treat things today. Like any field, medicine evolves. And staying current takes more than the occasional continuing ed course. It takes commitment, humility, and an understanding of our own limitations.

One question I've been thinking about lately is this: Are our healthcare providers always giving evidence-based advice, or are we sometimes getting anecdotal information based on personal opinion or outdated thinking?

Let me be clear - anecdotal information doesn't always mean bad information. But it's important to know the difference.

Experience ≠ Expertise

I've worked in outpatient orthopedics my entire career - post-op cases, spine issues, athletic injuries, joint replacements. That's my wheelhouse. But if someone came to me with a fresh stroke needing neuro-rehab, I'd refer them out. It's not my area of expertise, and pretending it is wouldn't serve the patient well.

The same principle applies across all healthcare professions. Whether it's PTs, MDs, or chiropractors, we each have a lane. The problem is, sometimes we drift outside of it - often unintentionally - and give advice that may be more anecdotal than evidence-based.

A Common Example in My World

Here's a real-world scenario I run into often: a client develops some knee or hip pain - not from a traumatic injury, just something that came on gradually. Maybe they did a little too much walking on vacation or overdid it in the yard. Nothing major, but it's nagging enough that they head to their doctor.

And here's where it gets tricky.

I'll hear that their physician told them to "shut it down," or that they "shouldn't lift anything heavy" and should "stick to light weights and high reps."

Sometimes that's appropriate. But more often than not, it's overly cautious advice rooted in outdated beliefs or a lack of experience with strength training. Many physicians - especially those who don't lift or coach - haven't designed a training program in their life. Yet they're giving prescriptive advice about how people should train.

That's not a knock on doctors. It's a call for all of us to stay in our lane and respect the nuances of other specialties.

Confidence vs. Caution

One of the most frustrating parts of this situation is the message it sends to the patient: "You're fragile. You shouldn't be doing this." That undermines all the progress we've made together - physically and mentally.

It takes time to build confidence in someone who's been sedentary or who feels limited by age or injury. And it doesn't help when they hear messaging that reinforces the idea they're broken or incapable.

Aches and pains are normal - especially if you're living an active life. Learning to navigate those discomforts is part of building a resilient body. Shutting everything down at the first sign of pain? That's often not the answer.

The Bottom Line

If you're a patient, know that getting a second opinion is okay - especially if the first one doesn't sit right with you. Once you've ruled out serious issues like fractures or tears, it's worth asking: Is this advice coming from someone with true expertise in this area? Or is it based on personal experience or caution rather than evidence?

If you're a provider, know your strengths. Lean into them. But don't be afraid to refer out or ask for help when something falls outside your scope. It doesn't make you less competent - it makes you a better practitioner.

Thanks for reading, and stay tuned for more insights in upcoming episodes of The CAIRN Strength Podcast. You can find us on Apple Podcasts and Spotify.

"How strong is strong enough?"

That's a question I often hear from patients and clients - and honestly, it's one I've struggled to answer until recently.

On a recent solo episode of the CAIRN Strength Podcast, I realized that answering this question isn't about hitting a specific number - it's about building your body's capacity before life pulls the rug out.

✅ Start by Defining "Too Weak"

Instead of chasing an arbitrary strength target, I encourage people to begin by asking: What does "too weak" look like?

• Simple functional tests - like the 30-second sit-to-stand or whether you can rise from a chair or bed without using your arms - are great benchmarks.
• If everyday tasks - like getting out of bed, standing up from a chair, or stepping into the bathtub - start to feel challenging or require assistance, it's a clear sign that your strength has declined and you're running dangerously low on physical capacity.
• Once you pinpoint that baseline, the message becomes clear: get stronger from here.

💪 My Two Stories of Strength and Frailty

I've seen this play out in real life, twice over:

1. One of my clients in his 80s dedicated himself to strength training - eventually deadlifting around 170 lbs for reps. When he suffered a hemorrhagic stroke and spent months immobilized, his strength paid off. His body rebounded faster, surprised therapists, and amazed his family.
2. My dad, once an active firefighter, became more sedentary after an injury and surgery in his 50s. Decades later, he fell down a flight of stairs and broke his hip, shoulder, and wrist. His recovery has been slow, largely because he didn't have a robust strength base to support it.

I often compare these scenarios to flying an airplane. If you're flying at 10,000 feet - with a strong baseline - you can handle unexpected turbulence. But if you're only 500 feet off the ground, there's little margin for error.

🎯 Strength as Your Safety Net

So when someone asks me, "How strong is strong enough?" my answer is simple:

• "As strong as you possibly can be," within your time, resources, and access to coaching or equipment.
• Because strength isn't just about lifting. It's about resilience
• Strong muscles support bone health, balance, and even cardiovascular fitness.
• If you face illness or injury - stroke, fracture, heart event - your body can bounce back more effectively.
• Strength helps you maintain independence and reduces the burden on those who care about you.

🔄 My Practical Takeaways 

1. Start with functional tests - chair rises, stair climbs.
2. Progressively lift heavier weights - this is how strength grows.
3. Start now - it's never too early or too late.
4. Track your progress - monitor reps, load, milestones.
5. Think long-term - treat strength as your personal insurance policy.

🧭 Wrapping It Up

Here's where I land:

1. Don't aim for "just enough."
2. Aim to be as strong as you can be.

Because life is unpredictable. Setbacks happen, but if we build a strong foundation now, we give ourselves the best chance to recover.

If you're new to strength training, you're not alone in feeling overwhelmed. With endless options like yoga, Pilates, boot camps, HIIT classes, and barbell training - not to mention the constant stream of online advice - it's hard to know where to begin. Everyone seems to have a different opinion about what's "best," what to avoid, and how to train "correctly."

At CAIRN Strength, we help people cut through that noise by focusing on what works. This blog will walk you through how to approach strength training with clarity, confidence, and results - no matter your starting point.

Why Simplicity Beats Complexity in Strength Training

One of the biggest mistakes beginners make is jumping into workouts that are too complicated. Fancy exercises on unstable surfaces or movements that require expert coordination may look impressive, but they often aren't effective for building meaningful strength - especially at the start.

Instead, focus on foundational, compound exercises like:

• Squats
• Deadlifts
• Bench Press
• Overhead Press

These multi-joint movements activate the most muscle mass and offer the greatest return on investment (ROI) for your time and effort.

Click the titles below to read more:

Final Thoughts: Start Where You Are, Build From There

The truth is, strength training doesn't have to be complicated - and it shouldn't be. You don't need to do every exercise or follow a perfect plan. You just need to start smart, stay consistent, and adjust as you go.

At CAIRN Strength, we help people train with purpose, whether you're brand new to exercise or looking to level up your program. If you're not sure how to begin or need help building a sustainable routine, we're here to guide you.

As we age, the natural process of aging brings about physical and metabolic changes that can affect our health and independence. These changes are often associated with a decline in strength, mobility, and bone density. Fortunately, research has shown that strength training can significantly help mitigate these effects, preserving independence, preventing frailty, and improving overall health. Here’s why strength training is crucial for older adults and how to implement it effectively.

Physical Activity Guidelines for Older Adults

According to the U.S. Department of Health and Human Services (HHS), physical activity is essential for everyone, including older adults. The guidelines suggest:

1. 75-150 minutes per week of vigorous-intensity exercise (e.g., running, shoveling snow).
2. 150-300 minutes per week of moderate-intensity exercise (e.g., brisk walking, raking leaves).
3. At least two days per week of strengthening exercises targeting all major muscle groups.

For older adults, strengthening exercises become even more important. These exercises help maintain muscle mass, improve balance, and enhance functional ability, all of which contribute to a higher quality of life and greater independence.

Why Is Strength Important?

Physical Implications of Strength

As we age, the body undergoes a series of changes that make maintaining strength more challenging but also more critical. Sarcopenia, the loss of muscle mass, and atrophy, the shrinking of muscle fibers, are two key conditions that impact older adults. Strength is essential because it helps combat these age-related changes, allowing us to:

1. Maintain Independence: Strength is needed for everyday tasks such as lifting groceries, cleaning, and climbing stairs.
2. Delay or Avoid Frailty: Frailty is a gradual decline in physical function, and strength training slows or prevents this process, ensuring you can stay active and functional into older age.

Health Implications

Strength is closely tied to various health outcomes, particularly as we age. Here are a few critical points:

1. Lower risk of all-cause mortality: Research shows that stronger individuals tend to live longer. In fact, studies have found that grip strength is a stronger predictor of death than systolic blood pressure.
2. Reduced risk of chronic diseases: Strength training is associated with a lower risk of conditions such as obesity, hypertension, hyperglycemia (high blood sugar), and high cholesterol. These conditions are often precursors to the sick aging phenotype, a condition marked by metabolic syndrome, obesity, insulin resistance, and muscle atrophy.
3. Improved bone health: Strength training stimulates bone growth and can help prevent or slow down osteoporosis, a condition that leads to weaker bones and increased fracture risk.

Our Physical World Becomes Smaller Without Strength

Without the strength to support daily activities, we face a gradual decline in our capacity to do things. From carrying groceries to playing with grandchildren or participating in community activities, we may find ourselves withdrawing from life as physical limitations grow. Strength loss reduces independence, and over time, this can make our world smaller.

What Is Strength and How Does Strength Training Help?

What is Strength?

Strength is the ability to exert force against an object. This ability is essential for nearly every activity we do, from lifting a heavy box to standing up from a chair. The more strength you have, the more independence you maintain.

Does Lifting Light Weights Make Us Stronger?

While lifting light weights can be beneficial for general health and endurance, lifting heavier weights is more effective at building strength. The key here is intensity and load. To stimulate strength adaptations, you need to engage the high-threshold muscle fibers, which are activated when lifting heavier weights, as opposed to low-threshold fibers activated during lighter, endurance-type exercises.

Does Yoga and Pilates Help Maximize Strength?

Both yoga and Pilates offer flexibility, balance, and core strength benefits, but they don’t fully maximize muscle strength. To increase strength, particularly for older adults, a more structured resistance training program that targets all major muscle groups is crucial.

What Type of Strength Training is Best?

For older adults, multi-joint exercises (exercises that engage multiple muscle groups) are ideal. These exercises not only save time but also provide a more comprehensive approach to strengthening the body. Examples include:

1. Squats
2. Deadlifts
3. Bench Presses
4. Push-ups
5. Rows
6. Lunges

These exercises engage large muscle groups and help build functional strength needed for daily activities.

How Much Intensity is Needed to Build Strength?

Recommendations for Untrained Individuals (Older Adults)

For older adults who are just starting out with strength training, moderate intensity is key. According to the American College of Sports Medicine (ACSM), for untrained individuals, strength training should include 70%-85% of your one-rep max (1RM), which translates to 8-12 repetitions per set. Initially, the intensity should correspond to a Rating of Perceived Effort (RPE) of 6-7, where the effort is challenging but not overwhelming. As strength improves, the RPE should progress to 7-8.

Recommendations for Trained Individuals

For more experienced individuals or those who have been training for some time, higher intensities are necessary to continue building strength. The ACSM recommends lifting 85%-100% of your 1RM for 1-6 reps with an RPE of 9-10 to maximize strength gains.

Combatting the Sick Aging Phenotype

The sick aging phenotype refers to the accumulation of various health issues, including obesity, insulin resistance, hypertension, high cholesterol, and muscle atrophy. These changes contribute to frailty, reduced mobility, and ultimately, a loss of independence. Strength training addresses this issue by:

1. Increasing muscle mass and preventing sarcopenia.
2. Improving metabolic function, which can help combat insulin resistance and obesity.
3. Maintaining bone density, reducing the risk of osteoporosis.
4. Increasing cardiovascular health, reducing the risk of heart disease and hypertension.

The good news is that strength training can help reverse or delay these changes, providing a higher quality of life and greater physical independence.

Conclusion

Strength training is not just about lifting heavy weights—it’s about maintaining and improving our ability to live independently, safely, and actively as we age. It can combat the effects of frailty, reduce the risk of chronic diseases, and help keep us functioning at a high level for as long as possible. Whether you are new to exercise or have been training for years, strength training should be an integral part of your fitness regimen. Start with the right intensity, focus on multi-joint exercises, and make strength a priority to combat the physical and health challenges of aging.

As we age, our bones naturally become weaker, and this is especially true for women after menopause. This can lead to a condition called osteoporosis, where bones become brittle and more prone to fractures. For years, doctors have recommended moderate exercise to help keep bones strong. However, recent research suggests that a more intense approach, such as high-resistance training, may be even more effective. One of the most important studies to investigate this topic is the LIFTMOR study, which examined the effects of a specialized exercise program on bone health in women aged 58 and above.

What is High-Intensity Resistance and Impact Training (HiRIT)?

High-intensity resistance and impact training, or HiRIT, involves lifting heavy weights and doing exercises that put pressure on the bones, which helps them become stronger. While this may sound risky for individuals with weaker bones, recent studies, such as the LIFTMOR trial, demonstrate that this type of training can be very safe and beneficial when performed correctly.

What Happened in the LIFTMOR Study?

The LIFTMOR study examined the effects of HiRIT on postmenopausal women with low bone mass. For 8 months, one group of women did high-intensity exercises twice a week, while another group did a gentle, low-intensity exercise routine at home.

The women who underwent high-intensity training (HiRIT) performed 5 sets of 5 repetitions at 85% of their 1-repetition maximum. Exercises included back squats, deadlifts, and overhead presses. These exercises were conducted under the guidance of professionals to ensure their safety. The results were impressive.

In contrast, the control group (CON) followed a low-intensity, home-based exercise routine. They did low-load resistance exercises like lunges, calf raises, and shoulder shrugs, with each exercise performed for 10 to 15 repetitions at less than 60% of their 1RM. They also included walking, balance work, and stretches. The intensity of the resistance exercises started with bodyweight exercises and gradually increased to a maximum of 3 kg hand weights in the final month of the program. The control group’s program focused more on improving balance and mobility, but did not provide as much stimulus for bone growth.

What Did the LIFTMOR Study Find?

1. Better Bone Health: The women who did HiRIT showed better bone strength, especially in the femoral neck (a part of the hip bone that’s very important for preventing fractures). While their bone mineral density (BMD) didn’t increase a huge amount, the HiRIT group did show improvements in the part of the bone that contributes the most to strength, which is the cortical bone. This is important because stronger cortical bone can help prevent fractures, especially in the hip.
2. Improved Strength and Balance: In addition to improving bone health, HiRIT also helped the women become stronger and more stable. Their muscle strength increased by about 25-35%, which is crucial for preventing falls. The study also showed improvements in balance, mobility, and functional movements like standing up from a chair or walking. These kinds of movements are directly linked to fall risk, so getting stronger and more balanced can help prevent falls and fractures.
3. Safe and Effective: One of the big concerns with heavy resistance training for people with osteoporosis is that it might cause fractures. However, the LIFTMOR study found no fractures or major injuries among the participants, even though they were doing intense exercises. This shows that, with proper supervision and technique, high-intensity training can be very safe.
4. Quality of Life: Beyond bones and muscles, the participants who did HiRIT also reported improvements in their ability to carry out everyday activities. Being stronger and more stable means they were less likely to feel afraid of falling and were able to do more things on their own, which can greatly improve quality of life.

What Does This Mean for You?

The results of the LIFTMOR study suggest that high-intensity training can be a very effective way to help strengthen bones and muscles, reduce the risk of falls, and improve overall health in women with low bone mass. While the idea of lifting heavy weights might sound intimidating, the study shows that it can be done safely, especially when done under the guidance of a trained professional.

This is a big shift from the traditional advice of doing only light or moderate exercise for bone health. High-intensity training, when done carefully and with proper guidance, can actually be a great option for improving bone strength, reducing the risk of fractures, and increasing overall physical function.

Next Steps

If you’re over 58 and have low bone mass, it’s worth considering high-intensity resistance training as part of your routine. However, it’s very important to work with a professional to ensure you’re doing the exercises correctly and safely. The LIFTMOR study shows that, with proper supervision and gradual progression, heavy resistance training can be a great way to protect your bones and improve your quality of life.

Remember, don’t try to do heavy resistance exercises on your own without professional guidance. You’ll want to start slowly and build up your strength under supervision to avoid injury. But with the right program, high-intensity resistance training could be an exciting and effective way to improve your bone health and physical fitness as you age.