What's the Difference Between Active and Passive Rehabilitation?
If you’ve ever had an injury you probably realised that there is a massive, and potentially overwhelming, number of options out there for helping you recover. Many people have a hard time figuring out what they should do or what will be best for them to get better. To help you decide on what strategy is best for you, you need to understand the difference between passive and active rehabilitation.
Much of the rehabilitation process, and a lot of the services that are available to you, are based on passive rehab strategies. These are all of the techniques that involve having something done to you. If you need some examples, think of all the different hands-on treatments you’ve seen before like massage, adjustments, manipulations, assisted stretching, acupuncture, etc. These are all passive techniques because you as the person being treated are not actively involved in the treatment. These strategies are all great for helping you feel more comfortable especially when you are experiencing a lot of pain.
Active treatment on the other hand is techniques where you are actually doing the treatment yourself under supervision of an expert. The most obvious example of course being exercise where you are instructed in what to do, but you do it yourself rather than having it done to you.
Both strategies are valuable in their own way, and work very well when paired together. To decide which one will suit you best though is going to require understanding the science of pain. Brace yourselves, a pain science lecture is coming.
If you find yourself asking how active rehab works, you are asking a complicated question with an even more complicated answer, but stick with me.
The first thing we need to understand for active rehab to make sense is understanding why we feel pain. Most people, myself included, were always told that pain is a sign of damage. If you experience pain, something is injured and has to be fixed. If this was the case, you would seek out some passive treatment to get an expert to fix what is broken.
Thankfully though, pain is actually more complex than that. It isn’t necessarily a sign of damage, it is your nervous system’s anticipation of a potential threat. This doesn’t make sense at first to most people so to make it easier to understand, let’s think about headaches.
Lots of people experience headaches for a variety of different reasons. Maybe you are dehydrated. Maybe you are stressed. Maybe you didn’t sleep well, were out in the hot sun all day, had a stressful day at work, and still have the long traffic-filled drive home ahead of you. Imagine for a moment that this is how your day went so far. Then imagine that you feel a headache starting to creep in. To most people, having a headache in a situation like that makes sense. You wouldn’t assume that your skull had broken. It’s just a headache and you had several different challenging things happen today. You’re not injured, it was just a rough day.
The same logic applies to pain elsewhere. If an elbow, knee, hip, back, or something else mysteriously starts to hurt, did you injure yourself? Not necessarily. It could just be the effect of several different factors all contributing to making your body feel threatened. Just because the mysterious pain isn’t in your head doesn’t necessarily mean that you’ve hurt yourself.
Now that we know why we feel pain, how in the world does this have anything to do with active rehab?
Remember how I said that pain is a sign of a threat? Well stress, sleep, diet, physical activity level, emotions, etc. can all contribute to making your body feel threatened. That being said, your body can also feel threatened by certain movements and activities. While passive rehab is excellent for making you feel better, if your body doesn’t learn that certain movements are not threatening, it will still react negatively when you try to do them.
This is why active rehab is so important. First of all, exercise is great for health in general. Secondly, getting stronger and fitter allows you to do daily tasks more easily. But the biggest benefit of active rehab is that it helps your body learn that it is safe to move.
For the sake of explaining this idea, let’s imagine that you have a sore knee (let’s hope you don’t actually though, of course). Let’s say that this sore knee is alright for most of the day, but if you walk for a long time, spend a long time on your feet, or bend it too far it starts to hurt. There are a variety of passive options for this that will all probably help you feel much better, but it sounds like there are some movements that should be safe for you to do, but your body thinks they are a threat. So whenever you try to walk, or stand, or bend, it hurts. What you need is gradual exposure to these movements to help your nervous system learn that they are actually normal and safe.
So what does this all mean for you? It basically means that adding movement that you do yourself is going to serve a huge benefit as you go through the process of rehabilitating your injury. If your body hurts too much to get active, passive treatments are a great way to get you comfortable enough that you are able to get moving. In the long-term though, it’s very important that you don’t avoid movement forever. Luckily, the human body is very adaptable and actually positively responds to gradual exposure to physical stress. It’s very common to be told negative things about your body like it “just isn’t what it used to be” or that it has “too much wear and tear”. This logic often applies to machines like your car. If you drive it more it will wear down. Your body is drastically different from a machine though and can actually make itself stronger to better handle movement if you move it regularly.
While passive strategies are very useful for getting someone’s help feeling better, long-term progress can be made by getting more active rather than avoiding movement.
The final bonus of active rehab is that it is something that you do yourself rather than having it done to you. So this puts your recovery in your own hands! With proper education and a plan for gradual introduction of movement, you can participate in active rehab whenever, wherever, and however you want. Rather than always having to go see somebody else to help you get better, active rehab gives you the power to help yourself.
In my opinion. The goal of the rehab process should be making sure people understand why their body feels a certain way, what steps to take to start feeling better, and most importantly, giving people the independence and the knowledge required to help themselves.
I want people to seek out rehab so they can work with an expert to decide on a plan to follow, but I don’t want people to have to rely on somebody else for help. The goal of rehab should be making sure that someone in pain has everything that they need to manage things on their own, whenever and however they want to.