24/08/2026
When conservative management “fails”… did it really fail?
This might be a slightly uncomfortable conversation, but it’s one I think we need to have more often.
I hear this all the time:
“I tried physio.”
“I tried rehab.”
“Conservative management didn’t work.”
And sometimes, yes — it genuinely doesn’t work, and surgery or another intervention may be the right next step.
But sometimes I wonder:
Was conservative management actually given enough time, consistency and progression to work?
The reality is that strength takes time.
We can often help settle pain relatively quickly.
But feeling better and being fully rehabilitated are not necessarily the same thing.
Pain may improve before the muscles, tendons and other tissues have regained the strength and load tolerance they need.
So someone stops their exercises because they feel better…
…and a few months later the pain returns.
Then the conclusion becomes:
“Physio didn’t work.”
But perhaps the body simply hadn’t finished adapting yet.
Think about strength training.
Doing a few exercises for two weeks is not the same as completing a progressive strengthening programme.
Your body adapts to the demands you place on it.
If an exercise becomes easy, it eventually needs to become harder.
More resistance.
More repetitions.
More load.
More complexity.
More functional challenge.
Progression is what creates adaptation.
And meaningful improvements in strength and capacity often take months, not weeks.
For many conditions, we’re looking at something more like 3–6 months of consistent, progressive work — sometimes longer.
And I completely understand that this is difficult.
Physiotherapy can be expensive.
People have jobs, families, financial constraints and busy lives.
Most people don’t want to spend months coming to physio every week.
And honestly?
You shouldn’t necessarily have to.
My goal isn’t to make you dependent on me.
Sometimes my job is to assess you, understand what is contributing to the problem, get you started with the right exercises, teach you how to progress them and then help you transition into a sustainable programme.
That might mean working alongside:
🏋️♀️ A biokineticist
🏃♀️ A knowledgeable personal trainer
💪 A strength and conditioning coach
🧘♀️ Another appropriate healthcare professional
…and then having periodic physio check-ins to reassess, modify and progress your programme.
Rehabilitation should be a team effort when that makes sense.
Here’s a simple example.
A runner develops lateral knee pain after suddenly increasing mileage, adding hills and doing more speed work.
We can settle the symptoms.
We can work on mobility.
We can modify the training load.
But if the underlying strength, movement control and capacity to tolerate running haven’t improved, the problem may return when the running load increases again.
So the goal isn’t simply:
“Make the pain go away.”
It’s:
“Build a body that can tolerate what you’re asking it to do.”
And this is just as important after surgery.
Surgery can address a structural problem, but the tissues still need to heal, muscles need to regain strength, movement needs to be restored and the body needs to progressively rebuild its capacity.
Otherwise, someone can understandably end up saying:
“My surgery failed. My knee is still not the same.”
When sometimes the surgery was only one part of the process.
And this is particularly important as we get older.
After 35 — and especially through perimenopause and beyond — maintaining and building muscle becomes increasingly important.
We shouldn’t be afraid of progressively heavier strength training.
We need to challenge our muscles enough to create adaptation.
We need to fuel that training.
And we need to recover.
Getting stronger doesn’t happen overnight.
But the good news?
🌟 Your body can adapt at almost any age.
🌟 Muscles can get stronger.
🌟 Load tolerance can improve.
🌟 Movement can improve.
🌟 Pain can change.
🌟 You can become more capable than you are today.
So if you feel like conservative management has “failed”, maybe ask yourself:
Did I strengthen consistently for long enough?
Was the programme progressively challenging?
Were we targeting the right things?
Did I stop because the pain improved — or because my capacity had actually improved?
This isn’t about blame.
It’s about hope.
Because sometimes the answer isn’t that your body can’t improve.
Sometimes it simply hasn’t yet had enough the right stimulus + consistency + progression + recovery + time.
And that’s what good rehabilitation is really about.
Strength still takes work.
There is no shortcut.
But it is absolutely possible to get stronger. 💪
