The Strength Gap Physical Therapy Keeps Missing

Pain can improve. Range of motion can return. A patient can pass testing and still leave rehabilitation without the strength or reserve required by sport, work, or daily life. Using persistent quadriceps weakness after ACL reconstruction as the opening example, Lou Fullenkamp examines the difference between giving someone an exercise and building an actual training stimulus. The discussion covers underdosing, load and effort, the limitations of manual muscle testing, progression toward meaningful intensity, and why late-stage rehabilitation should borrow more deliberately from strength and conditioning. The goal is not indiscriminate heavy loading. It is matching the dose to the adaptation once tissue tolerance allows.