| How We Treat
Exercise
The only treatment that changes the tissue itself — and the only one you keep, for free, for the rest of your life.
Muscle, tendon, bone, blood supply and blood sugar all adapt to what you repeatedly ask of them. This page explains how, how fast, and how we build a programme around your goal.
Overview
What Exercise Actually Does
Most treatments borrow time. Exercise buys it.
A needle can quieten a nerve for a fortnight. Hands can free a stiff joint for an afternoon. Shockwave can wake up a tendon that has stalled. All useful — but none of them change the tissue itself.
Loading does. It is the only treatment on this site where you are the mechanism, and the only one that leaves you stronger than you were before the injury.
Your body isn’t a machine wearing out. It is rebuilt continuously from the inside, and the blueprint it rebuilds to is written by what you regularly ask of it. Ask little, and it economises — muscle thins, tendon softens, bone gives back mineral it isn’t being asked to carry. Ask well, and it invests.
Worth knowing
Ross Edgley — a Loughborough sport and exercise science graduate before he was an adventurer — swam 1,780 miles around Great Britain over 157 consecutive days. The salt water destroyed the surface of his tongue. His body kept adapting anyway.
You are not swimming round Britain. But your shoulder, your Achilles and your back run on exactly the same rules.
The Mechanism
How Force Becomes Biology
Here is the part that sounds far-fetched and isn’t: your cells can read mechanical force, and they answer by switching genes on.
It’s called mechanotransduction, and it’s the reason exercise counts as a treatment rather than just good advice. A tablet changes how your cells behave by chemistry. Loading changes how your cells behave by force. Both end up in the same place — a cell doing something different from what it was doing before.
Four of the five steps below are that biological chain. The fifth is different, and worth knowing about on its own: some of what movement does isn’t biology at all. It’s plumbing.
This also settles an old argument. Too little load is not neutral — it’s an instruction, and your cells obey it. Both underloading and overloading are harmful; the useful zone is in between, and it’s called physiological loading.28
What Changes
Every Tissue Adapts — On Its Own Timescale
Different tissues respond at very different speeds. Knowing which clock you’re on is the difference between patience and panic. Tap a tissue below.
"But won’t I wear my joints out?"
It’s the most common worry about exercise, and it deserves the actual numbers rather than reassurance.
A systematic review of nine randomised trials in people at risk of, or already living with, knee osteoarthritis concluded that knee loading exercise does not appear to be harmful to cartilage — while noting honestly that the quality of the evidence was low.31
And in 25 studies covering 125,810 people, hip and knee osteoarthritis was found in 10.2% of sedentary controls, but only 3.5% of recreational runners. Competitive, high-volume running was different again at 13.3%.33
So the dose still matters. But the group with the healthiest joints wasn’t the group resting them.
Two honest qualifications
The running figures are an association, not proof. Runners may simply be people whose joints let them run — the authors say so themselves.33
And a stable joint is not the same as an unstable one. In an animal model where the ACL had been cut, forced exercise reduced lubricin and worsened cartilage damage.37 Loading a joint that can’t yet control itself is a different proposition from loading one that can — which is precisely what assessment is for.
The Principles
How Your Body Decides to Change
These principles are over a century old and haven’t needed replacing, because they describe biology rather than fashion. Every programme you leave here with is built from them — and knowing them means you can tell a plan from a pile of exercises.
The demand has to beat the habit
Tissue only changes in response to something harder than what it’s used to. Comfortable isn’t a dose.
How much harder? In a large 2025 analysis, every extra weekly set of resistance training added roughly 0.24% to muscle size and 0.21% to strength — on a curve of diminishing, but not disappearing, returns.1
It has to keep moving
Overload isn’t a setting you pick once. It’s a direction of travel. What was hard in week one is your new baseline by week four.
If the programme doesn’t climb, the adaptation stops — and this is the most common reason a set of exercises quietly stops working after a month.
You get what you train for
Adaptation is obedient, and it is literal. Train a muscle lengthening under load and lengthening strength rises 27%, while shortening strength rises 10%.2
Which is why your programme should look like your goal rather than like a generic gym plan. If the goal is carrying a kayak down the beach, somewhere in that programme there should be something being carried.
The same dose lands differently
Age, sleep, training history, medication, stress and genetics all change the response.
In an analysis of 151 trials and 6,306 older adults, lower volumes worked best for function, lean mass and muscle size, while higher volumes worked best for strength.3 The right dose depends on what you’re chasing and who you are — not on what worked for the person next to you.
The change happens between sessions
The session is the signal. The rebuild is the reply.
Tendon makes this vivid. After heavy loading, collagen breakdown actually outpaces building for the first 24–36 hours. Only then does the balance turn positive — and it stays positive for up to 72 hours.4
Load a tendon hard every single day, and you can spend a very long time in the wrong half of that curve.
Different tissues run different clocks, which is why your sheet says what it says. Cartilage recovers in about 15 minutes. Bone regains most of its sensitivity within 8 hours. Most strength work wants 48, and anything sprint-like wants 72 or more.27
“Training loads can only be considered excessive or inadequate based on the response to that load.”27 There is no number that is right for everybody — only what you did, how you responded, and what we do next because of it.
Use it or hand it back
The same responsiveness that builds you will unbuild you. Fitness fades fast: VO₂ max drops about 7% in twelve days of doing nothing.5
Muscle is far more stubborn, which is genuinely reassuring. In older adults, 12–24 weeks off produced no statistically significant loss of muscle size. Meaningful loss took 31–52 weeks.6
A missed fortnight is not a lost year.
The Side Effects
What You Get That You Didn’t Come In For
You arrive with a shoulder. You leave with a heart, a pancreas and a brain that all quietly benefited.
One session, three days of better blood sugar
Contracting muscle pulls glucose out of your blood without needing insulin at all. Insulin sensitivity stays improved by over 50% for up to three days after a single session — and is lost within five days of stopping.21
It adds up, too. In type 2 diabetes, a structured programme measurably improved long-term blood sugar control — while simply being advised to be more active did not.22
You grow new blood vessels
Three months of training increased the number of capillaries feeding each muscle fibre by 43% in older adults — a bigger response than in younger people.20
Capillaries are how oxygen and nutrients actually reach tissue. Growing more of them is your body improving the delivery route to the very thing you’re trying to heal.
It treats low mood, not just muscle
Across 218 trials and 14,170 people, exercise produced moderate reductions in depression. Walking, yoga and strength training were all effective — and strength training had among the best adherence.23
The most active live longest
In measured activity data from 36,383 adults, the most active quarter had roughly a quarter of the death risk of the least active. Light activity alone carried much of that benefit.24
Exercise is the only treatment here that makes you harder to injure next time.
How We Can Help You
Building Your Programme, Backwards From Your Goal
Everything above is useless until it’s pointed at something you actually want. So we start at the end.
1. Your goal, stated properly
Not “get rid of the pain” but “carry the kayak down the beach at Wells without my shoulder complaining for two days afterwards.” A goal with a task, a load and a deadline in it can be trained for — and can be tested.
2. The gap
Assessment works out what your goal demands and what you currently tolerate. The distance between those two numbers is your programme.
3. The starting point
Chosen so session one is achievable, honestly hard, and doesn’t flare you for three days. Some discomfort during rehab is safe — and in the short term, slightly better than avoiding it entirely.25
4. The rule for progressing
You leave knowing exactly what has to happen before the next step is earned — a rep count, a weight, a symptom response. So you’re never guessing between appointments.
5. Training around it, not just on it
If one tissue has to be unloaded for a while, everything else shouldn’t be. The principle from the sports medicine literature is to target the vulnerable tissue and “train around” it, so you don’t lose your overall capacity while one part recovers.27
It matters more than it sounds. In one study, players were 87% more likely to be injured in their first match back than average — but every additional training session completed before returning cut that risk by 13%.27
6. The re-test
Same measure, same interval. Progress becomes a number rather than a feeling — which is also how we find out quickly if the plan is wrong.
The part that isn’t in the programme
It would be neat if exercise were purely a matter of picking the right sets and reps. It isn’t, and pretending otherwise is one of the ways rehabilitation quietly fails.
Physiotherapy has spent years being told to treat the whole person, and then — as a recent analysis of the profession’s own literature argues — has often gone on to split people into a “physical” bit and a “psychological” bit, which is the very thinking it was meant to replace.30
That analysis found the thing actually holding it together was unglamorous: communication, and the relationship between you and your clinician. In their words, communication is the scaffold — the structure that lets everything else about your situation be explored rather than sorted into boxes.30
Which in practice means the programme is built with you and around your life, not handed to you. A perfect plan you won’t do is a worse plan than a decent one you will.
Where we won’t oversell it
Exercise isn’t painless, isn’t instant, and isn’t always the best option — sometimes a well-timed injection or an operation is simply the right tool, and we’ll say so.
Isometric holds are often sold as reliably reducing tendon pain. The best current analysis found they were not better than other loading, and that responses vary a lot between individuals.26 The heavy bone-loading protocols above were fully supervised, which is a different proposition from lifting heavy alone.
And adaptation is reliably slower than anyone wants. Expect the first honest read on a tendon programme at around twelve weeks, not two.
When to Seek Help
⚠ Stop and get assessed if you notice
- Pain that is severe, sudden, and came with a pop, tear or giving way
- Swelling that appears rapidly, or a joint that locks or won’t take weight
- Pain that wakes you every night and isn’t related to what you did that day
- Numbness, pins and needles, or weakness that is getting worse
- Unexplained weight loss, fever, or feeling generally unwell alongside the pain
- Pain that flares hard for more than 72 hours after every single session, despite reducing the load
Common Questions
Frequently Asked Questions
Is it safe to exercise when it still hurts?
In persistent pain, usually yes. A meta-analysis comparing programmes that allowed pain against pain-free programmes found a small advantage for allowing it in the short term, and no difference after that.25
The useful message is permission, not prescription: working into some discomfort is safe and doesn’t mean you’re causing damage. That’s a rule about long-standing pain, though — not about a fresh injury, and not a reason to ignore anything new or unusual.
How long before I see anything?
It depends entirely on the tissue. Strength changes in 2–4 weeks. Muscle size around 10 sessions. Tendon needs about 12 weeks for an honest read. Bone density is measured over 6–8 months.
What usually improves first is confidence and function — often well before the pain settles.
Do I need a gym?
For most goals, no. For bone and for maximum strength, you do need genuinely heavy load, and that’s easier to arrange with equipment.
Worth knowing: in the flexibility research, bodyweight-only exercise showed no significant gain in range. Load is what does the work.20
I’ve stopped for a few weeks. Have I lost everything?
Almost certainly not. Cardiovascular fitness fades quickly — around 7% of VO₂ max in twelve days. But muscle is far more durable: in older adults, 12–24 weeks off produced no statistically significant loss of muscle size.5,6
You also come back faster than you built it the first time. Restart lower than where you stopped, and climb.
Will lifting weights wear my joints out?
No — the evidence points the other way. Across nine randomised trials, knee loading exercise did not appear to harm cartilage in people at risk of or living with osteoarthritis.31 And cartilage quality actually improved in people who exercised three times a week for four months after meniscal surgery.32
Remember what cartilage is: a tissue with no blood supply, fed entirely by being squashed and released. Two years without normal loading thins it by around a quarter.34
Loading is how joints, tendons and bone stay healthy. Avoidance is what costs you.
My joints are stiff and creaky first thing — is that damage?
Usually it’s fluid, not damage.
Your joint surfaces are slippery because pressurised fluid inside the cartilage carries the load. Stay still and that pressure drains away — in the laboratory, friction rose 24-fold as fluid support fell from 89% to 9%.35 Move, and it re-pressurises.
Which is exactly why the first few steps are the worst and then it eases. “Motion is lotion” turns out to be measurably true — and the molecule that coats your joint surfaces is produced more when you move.36
How often should I do my exercises — every day?
It depends on what the exercise is asking of which tissue, which is why your sheet says what it says.
Gentle range-of-movement work, easy walking and isometric holds can usually be done daily — some of them more than once a day. Resistance work on the same muscles wants roughly 48 hours between sessions. Bouncy, springy tendon work and anything sprint-like wants 48–72 hours.27
The common mistake isn’t laziness. It’s doing the hard thing every day because it feels like it should help faster.
Should I be sore afterwards? Is soreness a sign it’s working?
Soreness is a poor guide to progress. It tells you a tissue was asked something unfamiliar — not that it adapted.
Some ache in the day or two after a new programme is normal and fine. What matters is whether it settles before your next session, and whether your numbers are climbing week on week.
Context matters too: the same soreness means different things in a hard week and an easy one.27
How little can I get away with?
Less than most people assume. For general health benefits, 30–60 minutes of strength work per week captures most of the mortality benefit.17
For a specific injury, the dose has to match the tissue and the goal — but “not much, done consistently” beats “a lot, done for three weeks” every time.
Where We Work
Exercise rehabilitation in North Norfolk
Tidal Physiotherapy is based in Wells-next-the-Sea, and exercise rehabilitation is available both at the clinic and on home visits across North Norfolk — including Fakenham, Holt, Burnham Market, Walsingham and Blakeney.
Appointments are with Brandon Dobson MSc, MCSP, HCPC registered. You do not need a GP referral, and we will tell you honestly at your assessment whether exercise rehabilitation is the right tool for your problem — or whether something else on this list is.
Not Sure If This Is Right for You?
Nothing on this page is a plan until it’s pointed at your goal. An assessment is where we work out which of these tools — if any — belongs in yours. If you have a scan report you don’t understand, bring it with you.
Book Your AssessmentOther Treatment Modalities:
References
- Pelland JC, Remmert JF, Robinson ZP, et al. The resistance training dose–response: a Bayesian meta-regression. Sports Medicine, 2025.
- Spudić D, Nosaka K. Eccentric versus concentric training: a meta-analysis. Sports Medicine – Open, 2025;11. doi:10.1186/s40798-025-00887-w
- Radaelli R, Rech A, Molinari T, et al. Resistance training volume in older adults: a network meta-analysis of 151 RCTs. Sports Medicine, 2024. doi:10.1007/s40279-024-02123-z
- Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nature Reviews Rheumatology, 2010;6:262–268.
- Codella R, et al. Detraining: physiological consequences of inactivity. Frontiers in Physiology, 2024;14:1334766.
- Grgic J. Effects of detraining on muscle size in older adults. Int J Environ Res Public Health, 2022.
- Damas F, Libardi CA, Ugrinowitsch C. The development of skeletal muscle hypertrophy through resistance training: the role of muscle damage and protein synthesis. European Journal of Applied Physiology, 2018;118:485–500.
- Schoenfeld BJ, Grgic J, Ogborn D, Krieger JW. Strength and hypertrophy adaptations between low- vs high-load resistance training. Journal of Strength and Conditioning Research, 2017;31(12):3508–3523.
- Bohm S, Mersmann F, Arampatzis A. Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis. Sports Medicine – Open, 2015;1:7.
- Radovanović G, Bohm S, Peper KK, et al. Evidence-based high-loading tendon exercise for 12 weeks leads to increased tendon stiffness and cross-sectional area in Achilles tendinopathy. Sports Medicine – Open, 2022;8:149.
- Qin L, Liu W, Cao H, Xiao G. Molecular mechanosensors in osteocytes. Bone Research, 2020;8:23.
- Turner CH. Three rules for bone adaptation to mechanical stimuli. Bone, 1998;23(5):399–407.
- Watson SL, Weeks BK, Weis LJ, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research, 2018;33(2):211–220.
- Gómez-Bruton A, et al. Swimming and cycling do not cause positive effects on bone mineral density: a systematic review. Revista Andaluza de Medicina del Deporte, 2016.
- Škarabot J, Brownstein CG, Casolo A, et al. The knowns and unknowns of neural adaptations to resistance training. European Journal of Applied Physiology, 2021;121:675–685.
- Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the PURE study. The Lancet, 2015;386:266–273.
- Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis. British Journal of Sports Medicine, 2022;56:755–763.
- Weppler CH, Magnusson SP. Increasing muscle extensibility: a matter of increasing length or modifying sensation? Physical Therapy, 2010;90(3):438–449.
- Alizadeh S, Daneshjoo A, Zahiri A, et al. Resistance training induces improvements in range of motion: a systematic review and meta-analysis. Sports Medicine, 2023;53:707–722.
- Zmudzka M, Zoladz JA, Majerczak J. The impact of ageing and physical training on angiogenesis in the musculoskeletal system. PeerJ, 2022;10:e14228.
- Bird SR, Hawley JA. Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport & Exercise Medicine, 2017;2:e000143.
- Umpierre D, Ribeiro PAB, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA, 2011;305(17):1790–1799.
- Noetel M, Sanders T, Gallardo-Gómez D, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ, 2024;384:e075847.
- Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality. BMJ, 2019;366:l4570.
- Smith BE, Hendrick P, Smith TO, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. British Journal of Sports Medicine, 2017;51(23):1679–1687.
- Clifford C, Challoumas D, Paul L, et al. Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis. BMJ Open Sport & Exercise Medicine, 2020;6:e000760.
- Gabbett TJ, Oetter E. From tissue to system: what constitutes an appropriate response to loading? Sports Medicine, 2024. doi:10.1007/s40279-024-02126-w.
- Dunn SL, Olmedo ML. Mechanotransduction: relevance to physical therapist practice — understanding our ability to affect genetic expression through mechanical forces. Physical Therapy, 2016;96(5):712–721.
- Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine, 2009;43(4):247–252.
- Daluiso-King G, Hebron C. Is the biopsychosocial model in musculoskeletal physiotherapy adequate? An evolutionary concept analysis. Physiotherapy Theory and Practice, 2020. doi:10.1080/09593985.2020.1765440.
- Bricca A, Juhl CB, Steultjens M, Wirth W, Roos EM. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. British Journal of Sports Medicine, 2019;53(15):940–947. doi:10.1136/bjsports-2017-098661.
- Roos EM, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis & Rheumatism, 2005;52(11):3507–3514. doi:10.1002/art.21415.
- Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 2017;47(6):373–390. doi:10.2519/jospt.2017.7137.
- Vanwanseele B, Eckstein F, Knecht H, Stüssi E, Spaepen A. Knee cartilage of spinal cord-injured patients displays progressive thinning in the absence of normal joint loading and movement. Arthritis & Rheumatism, 2002;46(8):2073–2078. doi:10.1002/art.10462.
- Krishnan R, Kopacz M, Ateshian GA. Experimental verification of the role of interstitial fluid pressurization in cartilage lubrication. Journal of Orthopaedic Research, 2004;22(3):565–570. doi:10.1016/j.orthres.2003.07.002.
- Roggio F, Petrigna L, Trovato B, Di Rosa M, Musumeci G. The role of lubricin, irisin and exercise in the prevention and treatment of osteoarthritis. International Journal of Molecular Sciences, 2023;24(6):5126. doi:10.3390/ijms24065126.
- Elsaid KA, Zhang L, Waller K, et al. The impact of forced joint exercise on lubricin biosynthesis from articular cartilage following ACL transection. Osteoarthritis and Cartilage, 2012;20(8):940–948. doi:10.1016/j.joca.2012.04.021.