The terms passive and active apply to all physical therapies, and refers to the state you are in during therapy. Passive therapy techniques are those that do not require the patient to exert physical effort to participate in treatment. Instead, passive therapies rely on the therapist to administer all of the necessary care manually.
Passive therapy like massage and most physiotherapy means you are being worked on or manipulated rather than initiating or actively participating in the movement yourself. Active therapy like kinesiology means you are self-actuating the movement, activating your own muscles to push, pull or move. That sounds simple, but what does an active approach really mean for therapy, what passive therapies am I referring to, and what are the active treatment alternatives?
Active and passive treatments have their pros and cons, so which is better? The answer isn't clear-cut, but should be based on the level of severity and your goals. To find out what therapy is best for you, let's take a closer look at passive and active physical therapies.
Examples of passive treatments
I’ll start this by saying passive therapy as a management or intervention is the norm. There’s nothing wrong with passive therapy, and in fact it is core to most health and rehabilitation plans. Passive treatments include common physiotherapy, chiropractic, and RMT techniques. In the broadest sense passive therapy also includes medicine. For these therapies there is an obvious distinction between active and passive: you are exerting force and/or moving, or you are receiving the therapy without your own effort.
In general, if you are lying down, seated, or simply not moving very much, you are most likely receiving passive therapy. Note that some categories of passive treatment have active components, if your chiropractor assigns exercises for example. For passive treatment, think of lying down for a massage, or receiving needles in acupuncture.
Physiotherapy (Passive Physiotherapy e.g. I.M.S.)
Passive physio treatments include IMS (Intramuscular Stimulation, aka dry needling) and manual tissue and joint manipulation, ultrasound and electrical stimulation. These are passive treatments because you remain in a relaxed position to receive them. Passive physiotherapy treatments can be incredibly effective for relaxing muscles, pain management, reducing inflammation and regaining function more quickly.
Chiropractic is a health care profession that focuses on the diagnosis and treatment of mechanical disorders of the musculoskeletal system, with special emphasis on the spine. Chiropractors use hands-on techniques, including manipulation of the spine, to adjust joints and relieve pain. Network Spinal is another chiropractic technique targeting the nervous system and is also passive. Chiropractic is a very effective passive therapy for reducing pain and inflammation.
Massage therapy is a form of treatment that uses hands-on manipulation of the soft tissues of the body. Registered massage therapists (RMTs) use massage to help clients relax, relieve pain, and improve circulation. Massage therapy can be used to treat a wide variety of conditions, pain, headaches and lymphatic issues. If you're looking for pain management, or simply want to relax and feel better, massage may be the passive therapy solution for you.
Acupuncture is a form of Traditional Chinese Medicine (TCM) that has been practiced for centuries. It involves the insertion of very thin needles into specific points on the body to treat various health conditions. Acupuncture is often used in conjunction with other TCM therapies, such as cupping and herbal medicine. It is a passive treatment as you are not exerting effort in order to receive it.
Should I consider passive treatment
If you're considering whether to use passive or active therapy for your treatment, keep in mind severity and goals.
First, think about the severity of your condition. If it's acute and resulting from trauma, I observe most clients gravitate to passive interventions. For example a client with a broken bone might start at a doctor, and quickly progress to physiotherapy. Manual manipulations and adjustments from a physiotherapist or chiropractor are passive treatments and are well suited for acute soft tissue injuries.
Second, consider your goals for treatment. If you're looking for a quick relief, passive therapy may be a good option. Think about it, if you have a painful muscle spasm which feels like an isolated sharp pain, then a massage or chiropractic adjustment could be very helpful for quickly relieving those tense muscles. This can provide quick, short term pain relief and promote blood flow and healing.
These are evidence based guidelines but make sure to talk to your doctor about which option is right for you. From our experience even clients with acute injuries progress most by starting active interventions right away.
Examples of active treatments
Physiotherapy, kinesiology, therapeutic yoga and pilates use active techniques that can help improve your body’s movement and function by having clients actively participate in treatment. Each type of treatment program has its own unique benefit, and all are recommended for pain management, injury prevention and recovery or just working towards better body function.
Active physiotherapy and exercise therapy
Physiotherapy techniques can be categorized as either active and passive. Active physiotherapy is when the patient performs exercises or exerts effort to promote movement and healing such as PNF (proprioceptive neuromuscular facilitation), which is an advanced form of stretching. If you visit a physiotherapist, you are likely to receive both types of therapy, whichever is best suited for your rehab.
For me the most familiar active component of my physiotherapy visits is getting homework between sessions. Individual physiotherapists and clinics vary in the 'hands-on' approach; depending on who you see you'll have different levels of active/passive.
What I’ve seen in the industry is a trend towards rehab facilities with fewer treatment rooms and more access to gym space, providing a heavy active component. Kinesiologists work very well alongside physiotherapists in these environments.
A session with a kinesiologist is predominantly an active treatment. This active therapy builds on the principles of human movement, strength and conditioning, biomechanics, and healthy lifestyle change. Taking place in a gym space, outside, or in your own home, kinesiology treatment includes moving your own body under direction of a kinesiologist to increase strength (against a resistance), and range of motion (stretching/foam rolling, trigger point rolling).
Just like some physiotherapy treatment, you would also receive direction for completing exercises at home to progress you more quickly towards your goals. Kinesiologists guide you with safe exercise programming and form education while you perform each action.
As we look more deeply at kinesiology techniques, we sometimes hear of passive range of motion exercises. Here you would still be actively participating in your own movement, however, you might be assisting your injured side (which is completely relaxed) with your uninjured side in a way that limits pain and increases range.
You can find out more about who can benefit from kinesiology here.
If you are having trouble with exercise or mobility on dry land and are interested in active therapy there is a solution: aquatic therapy. This type of therapy takes place in an aquatic environment like a pool. The buoyant force of water opposes gravity and allows clients with limited movement an opportunity to get more effective exercise. The client is not required to swim and in some facilities can even access treatment from a wheelchair.
Therapeutic Yoga is a holistic approach to health and healing that weaves together ancient yogic practices including breath techniques, hand gestures, vocal tones or chanting and gentle movement. How therapeutic yoga differs from other types of yoga is up to the practitioner but can broadly be thought of as a more gentle form of yoga.
Clinical Pilates is a system of exercises developed to assist in injury rehabilitation, normally administered by a physiotherapist or kinesiologist. Emphasis is on core stability, posture control and movement, making it perfect for individuals who have been injured or are physically challenged by their condition.
Should I consider active therapy treatments?
Which type of treatment is right for you brings us back to our earlier consideration of severity and goals for treatment.
Medicine and physio are moving in the direction of active treatments - for example today a full cast and sling for broken limb is rare, because patients need the free movement of their limb more than the protection offered by the cast. The surge in popularity of clinical pilates in physiotherapy (driven by clients and practitioners) also aligns to the general shift towards active therapy.
And the growth of the profession of kinesiology is a similar indication that active therapy is gaining popularity for rehab. Movement is how clients get better faster. Clients seeking active therapy with a kinesiologist can workout like personal training, or do more physio-like rehab or anything in between. Kinesiologists can help throughout rehab by putting careful consideration to the degree of trauma and pain when administering their program.
And the benefits are not limited to rehab. Kinesiologist using active therapy can help in different types of people in a variety of situation from youth to athletes to retirees.
Our experience as a kinesiology studio gives close insight into this niche in the health industry. We specialize in helping our clients overcome injury and pain and commonly see rehab clients who have already been diagnosed by a doctor or physiotherapist.
These clients are ready to make the jump from passive to active therapy. And from the point where a client finds our services, we can help them through the rest of their rehab and health journey. This is especially beneficial for clients seeking progress on long-term, nagging injuries and chronic pain, but holds true early in rehab too.
Early vs later stages of rehabilitation
Physiotherapy is a great first option for clients with acute injuries in need of rehab for getting a diagnosis which kinesiologists can’t provide manual manipulation while the tissues are still inflamed. However, whether seeing a physiotherapist or kinesiologist with an acute injury, active movement shouldn't be delayed. In this early stage of recovery, active rehab is easily achievable when kinesiologists work closely with PT's in the acute phase.
At some point in a clients’ health journey there develops more focus on getting back to the activities they used to do. These clients at a later stage in the rehab journey are best suited to active therapy. They are ready to take their progress to the next level and build back their strength, balance and agility enough to participate in hikes, sports or other daily-life activities. In short they want to return to the activities they were not able to do during their initial stages of rehab.
Active vs. passive treatment: What’s better?
Passive therapy is a fine first response and treatment to muscle and body pain, and active therapy can complement this. Whether you have an acute injury, you’ve hit a plateau with your other treatments, or you have your sights on a specific activity you want to return to, kinesiology and active therapy might be the right option. Make sure to ask your doctor and current health team to find out if you’re ready for active therapy.
What about Counseling for rehab?
Not only is counseling a great way to address personal issues and emotional disorders, for many people it is essential for addressing pain, and especially chronic pain in a rehab context. Pain must be addressed in relation to our physical, psychological, and social selves to achieve a full recovery. Counseling provides a safe and confidential place for you to explore your thoughts, feelings and behaviors contributing to psychological and social well being.
Active and passive can have slightly different meanings in relation to counseling and refer to greater or minimized verbal directive (e.g.: “have you thought about this option?” vs. “what other options have you considered?”). Compared to active in the context of this blog, counseling is very active treatment for the mind during and following therapy. Counseling clients experience more positive beliefs, productive behaviors and decreased pain.
All therapies can be placed into one of two categories: passive or active treatment. Passive therapies are those in which you are limited in your movement, while active therapies require you to initiate and exert energy. Each type of therapy has its own benefits, and it’s important to understand the difference so that you can choose the right treatment for your needs.