Treatment of Spine Problems – Active vs. Passive
Generally, non-surgical management of back problems can be divided into two types of care: Passive and Active.
Passive treatments are things that are done to you in an effort to alleviate your pain and improve your mobility. This means that you, as the patient, do not typically do much, other than present yourself to the clinic and allow the health care professional to administer the therapy.
Examples of Passive treatments are:
⦁ Spinal manipulation: Typically performed by chiropractors, although lately there has been more interest by the physiotherapy community in utilizing this type of treatment.
⦁ Physiotherapy modalities: These are things such as ice, heat, ultrasound, interferential current, TENS, traction.
⦁ Massage Therapy
⦁ Medication (anti-inflammatory, pain-killers)
Active treatments are things that you actively participate in to try and alleviate your pain and improve your mobility, strength and fitness. It is important to realize that greater than 95% of your day is spent outside of your therapists’ office. What you do, for yourself, is actually more important than what your therapist does to you. As you transition into stages 2 and 3 your therapists’ primary role is in educating you as to what you can and should do for yourself.
Examples of Active treatments are:
⦁ Education: Actively engaging in educating yourself as to the nature of your problem so that as treatment proceeds you are more capable of taking responsibility for long-term management of your back.
⦁ Active rest: Remaining active in a fashion that does not create more injury. This typically involves activity modifications such as choosing different activities or modifying the amount of time spent doing a certain activity. This is imperative to do when you have back pain instead of complete rest, which we now know is harmful over the long term.
⦁ Exercise: There is no “one size fits all” exercise program for people with back pain. You will need to work with a heath care professional to develop an exercise regime that is right for you.
Treatment typically follows a three-staged approach:
⦁ Pain control; most people limit the treatment they receive to ones that focus on immediate pain control. Long-term resolution is only achieved by progressing through all three stages of recovery (see stage 1)
⦁ An early, safe return to normal activity (see stages 2 and 3). In the acute stages after an injury, the average person will lose between 1-3% of their muscle strength per day. This effect does not automatically reverse itself when your pain has resolved. It is not necessary to have achieved complete pain relief before starting your active rehab program. Remember that hurt does not always equal harm, so it is entirely possible for you to progress into functional restoration even if you continue to experience discomfort. We have known for some time now that lack of physical activity is directly linked to ill health. We have also known for a long time that ongoing stiffness and weakness (deconditioning) in the injured part of the body is the number one cause of ongoing disability.
One of the additional difficulties that people encounter today is that technology has allowed us to be more sedentary in our activities of daily living (see Risk Factors for Spinal Pain). Instead of walking, we drive; rather than climb stairs, we use elevators etc. While once we were regularly active, we now spend much of our lives sitting at desks and in front of computers. The result of this sedentary lifestyle is that of we have already become progressively less fit and less flexible than our parents generation – even before we got hurt.
The only way to prevent or reverse this deconditioning effect, as well as the diseases and disabilities associated with inactivity, is to remain active (see “DocMikeEvans” video 23 ½ hours). When resuming a more active lifestyle it is important to realize, however, that exercise is another stress on the body. If we stress our bodies in a correct manner, and then allow it sufficient time to recover the body will respond by making itself stronger. This phenomenon is referred to as a Training Effect. Naturally, you should consult with a healthcare professional to help guide you through this process to ensure you are not overdoing it as you begin to get active. Inappropriate introduction of activity may temporarily re-aggravate you, forcing you to cycle back into Phase I. You will likely need to undergo treatment and active rest again as you deal with achieving Pain Control again. This can be very frustrating, and lead to the abandonment of treatment. We will review how to do this properly during the course of your treatment.
⦁ Encouragement to pro-actively manage your health through a wellness model. Once your level of fitness is sufficient to return to normal function it is your responsibility to maintain it. This is sometimes difficult to do when you are no longer in pain. It may help to think of your body as a finely tuned piece of machinery such as your car. It is a lot cheaper to keep your car in good working order than to fix it once it has broken down. The same is true of your body. (AND IT HURTS A LOT LESS TOO!!)