Weights & Resistance Training in Physiotherapy: A Cornerstone of Recovery

What is resistance training with weights?

Resistance training with weights — dumbbells, ankle weights, or other free weights — means exercising your muscles against an external load. When the load is increased gradually over time, it is called progressive resistance training (PRT), and it is one of the most effective and best-evidenced tools in physiotherapy.

It is not about lifting heavy in a gym; even light, well-chosen weights, progressed sensibly, produce meaningful gains in strength and everyday function.

How it works

Muscles adapt and grow stronger when they are regularly challenged beyond their comfort — the principle of progressive overload. As you get stronger, the weight is gradually increased so the muscles keep adapting.

Weights provide a constant load throughout the movement, which makes it easy to measure and step up the challenge in small, precise increments. A physiotherapist uses this to match the load to your condition and goals.

What it is used for

Resistance training is a core part of rehabilitation for a wide range of goals, including:

• Osteoarthritis of the knee and hip (pain and function)
• Recovery and preparation ("prehab") around knee and hip replacement
• Rebuilding strength after injury or surgery
• Strength, function, and independence for older adults
• Countering age-related muscle loss (sarcopenia) and supporting bone health

What the evidence shows

The evidence for resistance training is among the strongest in physiotherapy. A landmark Cochrane review pooling 121 randomised trials (around 6,700 older adults) found progressive resistance training produced large gains in muscle strength and clear improvements in everyday function — walking speed, rising from a chair, and complex daily activities — with participants who had osteoarthritis reporting less pain.

For knee osteoarthritis specifically, a Cochrane review found land-based exercise (including strengthening) produces moderate reductions in pain and improvements in function that are sustained for months after treatment. This is why leading clinical guidelines — from the American College of Rheumatology and OARSI — strongly recommend exercise, including strengthening, as a core first-line treatment for hip and knee osteoarthritis. Resistance training before joint-replacement surgery ("prehab") also improves post-operative function and strength.

Resistance training additionally helps counter sarcopenia (age-related muscle loss), improving strength and function, and can support bone health. The honest note: the biggest gains come from consistent, progressive training, ideally guided; and while strength and function improve reliably, gains in actual muscle mass are smaller and less consistent. Used with a physiotherapist, it is a genuinely powerful, evidence-based treatment.

Using it at home

Weights are portable and well suited to home programmes, with easy and precise ways to step up the load. A physiotherapist chooses the exercises, sets the starting weight, and plans safe progression for your specific situation. Guided and supervised programmes are consistently linked to the best outcomes.

Safety and technique

Resistance training is safe and highly beneficial when done well, but technique and progression matter.

• Use correct form and controlled movements; do not sacrifice technique for heavier weight.
• Progress the load gradually — some temporary muscle soreness is normal, but stop for sharp or joint pain.
• Take extra care with uncontrolled high blood pressure (avoid breath-holding or straining).
• Respect any post-surgery movement restrictions, and avoid loading an acutely injured area until cleared.
• Have a physiotherapist set and progress the programme for your condition — supervision improves both safety and results.

Sources

• Liu C-J & Latham NK. Progressive resistance strength training for physical function in older adults. Cochrane, 2009 (121 RCTs)
• Fransen M, et al. Exercise for osteoarthritis of the knee. Cochrane, 2015
• Kolasinski SL, et al. 2019 ACR/Arthritis Foundation guideline for management of hand, hip & knee OA, 2020

Other modalities

• TENS (transcutaneous electrical nerve stimulation)
• Therapeutic ultrasound
• Muscle stimulation (NMES / EMS)
• Interferential current therapy (IFC)
• Heat and cold therapy
• Low-level laser / red-light therapy (LLLT)
• Resistance bands
• Pneumatic resistance training
• Cable functional trainer
• Motorised cycling therapy
• Supported treadmill gait training