Strength is an essential cornerstone for human health. Higher levels of muscular strength are associated with a lower risk of all-cause mortality, reduced falls, and greater functional independence across the lifespan [Citation1,Citation2]. Conversely, the loss of strength and skeletal muscle mass (sarcopenia) is associated with higher all-cause mortality [Citation3] and an increased risk of disability, falls, and poorer quality of life [Citation4,Citation5]. Public health guidelines, including those from the World Health Organization, strongly recommend strength training for all adults, at least twice weekly [Citation6]. In short, strength matters. In the rehabilitation of a person seeking care for pain associated with the musculoskeletal system, two questions are important: The first; is improvement in muscular strength important for recovery, and the second, should we be measuring it clinically? We wish to debate these questions with reference to a common musculoskeletal problem: rotator cuff-related shoulder pain (RCRSP), where assessing and improving strength are commonly prioritized as a major aim of treatment [Citation7,Citation8]. After pain and loss of movement, diminished muscular strength is often considered a core feature of the impairments associated with RCRSP [Citation9,Citation10]. Strength impairments are widely assumed to explain functional limitations and to justify targeted resistance training. However, how certain are we that shoulder weakness causes pain, or improving strength reduces symptoms?

This perspective paper examines the clinical and conceptual value of strength testing in RCRSP. It evaluates how strength is measured, whether it reliably guides treatment, and if it mediates recovery. We argue that similarly to the concept of ‘poor posture,’ ‘a lack of strength’ has become a convenient but misleading proxy used to explain a person’s symptoms and ‘by correcting it,’ a mechanism of improvement. We recognize that getting stronger is one of the greatest physical gifts a person can give to their current and future self, but that in the context of clinical rehabilitation timeframes, clinically important improvements in strength are unlikely to occur, and are not essential for clinically relevant outcomes. This has implications not only for the importance we place on increasing strength, but also for the way we measure strength and apply clinical reasoning to the findings in contemporary clinical practice. Our paper should not be seen as an argument against resistance exercise, but as a call not to conflate what happens in a ‘gym’ with what happens in a clinical environment.