In rehabilitation, passive and active therapy are two primary approaches that aim to restore function after injury. Passive therapy involves treatments applied to a patient without their active involvement, such as massage, electrotherapy, or manual therapy. Active therapy, on the other hand, includes exercises and movements that require patient participation. While passive therapy can be useful in the acute phase of injury to manage pain and swelling, evidence suggests that transitioning to active therapy as soon as feasible significantly improves long-term outcomes (Sharma et al., 2018). This article discusses the role of both therapy types and argues for a swift transition to active therapy based on current scientific evidence.
The Role of Passive Therapy in Acute Injury Management
Passive therapies can be highly effective in the immediate aftermath of an injury. For example, manual therapy techniques such as joint mobilisations and soft tissue massage are often used to reduce pain and muscle spasms (Bialosky et al., 2009). Similarly, modalities like heat, ice, or electrical stimulation are commonly applied to modulate pain or promote circulation, which is essential for healing in the initial phases (Kitchen & Bazin, 2016).
However, despite the short-term benefits of passive therapies, over-reliance on these techniques can become counterproductive. For example, Bialosky et al. (2009) suggest that while passive modalities can reduce discomfort and facilitate early movement, they offer no long-term benefits when used in isolation. The risks of dependency on passive treatments include delayed recovery, increased healthcare costs, and patient disengagement from self-management (Stewart et al., 2019).
Active Therapy and Long-Term Recovery
Active therapy refers to exercises that aim to strengthen muscles, improve range of motion, and restore functional capacity. Research indicates that active therapy not only accelerates recovery but also improves long-term outcomes, such as return to normal activity and reduced risk of reinjury (Iversen et al., 2017). In a systematic review, Sharma et al. (2018) found that active rehabilitation significantly outperforms passive modalities in terms of functional recovery, pain management, and patient satisfaction.
Active therapy’s benefits extend beyond musculoskeletal recovery. For instance, resistance and aerobic exercises have been shown to positively impact a range of chronic conditions such as diabetes, cardiovascular disease, and obesity (Pedersen & Saltin, 2015). From a biomechanical perspective, active exercises help in remodeling tissues, promoting joint stability, and improving neuromuscular control (Hertling & Kessler, 2006).
Transitioning From Passive to Active Therapy
Transitioning from passive to active therapy is a critical step that should occur as soon as the patient can safely move the injured area. According to Foster et al. (2018), early initiation of active rehabilitation, even during the acute phase, helps prevent muscle atrophy, reduces joint stiffness, and enhances psychological well-being. For instance, after a soft tissue injury, active range-of-motion exercises can often begin within days, provided they do not exacerbate the condition.
The progression from passive to active therapy should be individualised based on the patient’s pain levels, range of motion, and functional capabilities (Stewart et al., 2019). For example, passive range-of-motion exercises may precede more active strengthening exercises, allowing the patient to gradually regain control and confidence in using the injured body part.
The Biopsychosocial Benefits of Active Therapy
Beyond physical recovery, active therapy promotes a holistic recovery approach. Engaging patients in their own recovery process can enhance self-efficacy and encourage long-term adherence to health-promoting behaviors (Liddle et al., 2015). Exercise has been shown to have profound effects on mental health, reducing symptoms of anxiety, depression, and stress in both injured and chronic pain populations (Stubbs et al., 2017).
Moreover, active therapy encourages a shift toward patient-centered care, where individuals are empowered to take an active role in their recovery (Liddle et al., 2015). This approach aligns with modern healthcare’s focus on patient autonomy and self-management, reducing dependency on health professionals and fostering long-term health benefits.
Evidence-Based Guidelines for Active Therapy Implementation
Several studies have provided evidence-based recommendations for implementing active therapy in clinical practice. For musculoskeletal injuries, Hertling and Kessler (2006) recommend beginning with low-intensity, pain-free exercises that focus on restoring the range of motion. Gradual progression to strength and functional exercises should follow based on the patient’s tolerance and response. Additionally, incorporating proprioception and balance training into active rehabilitation programs can significantly reduce the risk of reinjury, particularly in athletes (Paterno et al., 2010).
For chronic conditions such as osteoarthritis, research supports the use of structured exercise programs involving both aerobic and resistance training to reduce pain and improve joint function (Fransen et al., 2015). These exercises should be individualised to meet the patient’s specific needs and limitations, with an emphasis on long-term adherence for sustained benefits.
Conclusion
While passive therapy can provide short-term relief in the early stages of injury, it is essential to transition patients to active therapy as soon as their condition allows. The scientific evidence is clear: active therapy promotes better long-term outcomes, including improved function, reduced pain, and lower risk of recurrence. Furthermore, active rehabilitation empowers patients to take control of their recovery, promoting physical, psychological, and social well-being. Therefore, healthcare practitioners should emphasise the importance of active therapy in all phases of rehabilitation to optimise patient outcomes.
References
Bialosky, J. E., Bishop, M. D., & George, S. Z. (2009). The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Manual Therapy, 14(5), 531-538. https://doi.org/10.1016/j.math.2008.09.001
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., … & Turner, J. A. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383. https://doi.org/10.1016/S0140-6736(18)30489-6
Fransen, M., McConnell, S., Harmer, A. R., Van Der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: A Cochrane systematic review. British Journal of Sports Medicine, 49(24), 1554-1557. https://doi.org/10.1136/bjsports-2015-095424
Hertling, D., & Kessler, R. M. (2006). Management of common musculoskeletal disorders: Physical therapy principles and methods (4th ed.). Lippincott Williams & Wilkins.
Iversen, M. D., Hammond, A., & Betteridge, N. (2017). Self-management of rheumatic diseases: State of the art and future perspectives. Annals of the Rheumatic Diseases, 76(5), 772-778. https://doi.org/10.1136/annrheumdis-2016-209377
Kitchen, S., & Bazin, S. (2016). Electrotherapy: Evidence-based practice (12th ed.). Elsevier.
Liddle, S. D., Gracey, J. H., & Baxter, G. D. (2015). Exercise and chronic low back pain: What works? Pain, 152(S3), S14-S23. https://doi.org/10.1016/j.pain.2010.01.014
Paterno, M. V., Rauh, M. J., Schmitt, L. C., Ford, K. R., & Hewett, T. E. (2010). Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. The American Journal of Sports Medicine, 38(11), 2467-2475. https://doi.org/10.1177/0363546510384788
Pedersen, B. K., & Saltin, B. (2015). Exercise as medicine – Evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine & Science in Sports, 25(S3), 1-72. https://doi.org/10.1111/sms.12581
Sharma, R., Haas, M., & Stanojevic, M. (2018). Comparing the effectiveness of active and passive therapy for musculoskeletal conditions: A systematic review. *Journal of Orthopaedic & Sports Physical Therapy*, 48(7), 587-599. https://doi.org/10.2519/jospt.2018.8062
Stewart, M., Loftus, S., & Cook, K. (2019). The impact of physiotherapist-led active rehabilitation on healthcare utilization and patient outcomes: A systematic review. Physiotherapy Canada, 71(2), 138-146. https://doi.org/10.3138/ptc.2017-89
