Got pain – Active approach vs Passive approach.

Pain is one of the most common reasons for a persons visit to the outpatient clinic.

In one end of the spectrum is the active approach where the emphasis is on staying active and doing things with a certain bias of pushing through the pain. The “No pain, No gain” approach.

The other end of the spectrum is the passive approach where there is a tendency to seek passive models of care ranging from the use of electrotherapy equipment, manual therapy, braces and supports. 

While the passive approach certainly has the benefit of accomplishing pain relief over a short term, it seems to always come with a certain limitation in terms of function. There are activities that one would never be able to do with out the fear of causing and increasing the pain.

With the full-on active approach, the down side is one may end up with more pain and discomfort, especially when the underlying factors are not fully addressed. In this spectrum also comes situations where some people rely on Dr. Google and end up doing some seemingly interesting exercises and end up hurting themselves even more. 

I sincerely hope that this pun is taken in the right sense and that there is no one actually named “Dr. Google”.

In our practice, we believe in a balanced approach. we assess the person to understand the contributing factors of pain and address all those that fall under our circle of competence. Depending up on the severity of pain and dysfunction, we balance the choice between passive and active interventions.

If the person has increased severity of pain and dysfunction, we often choose the passive model first, the goal is to decrease the pain and get the person comfortable. Often times it would involve modifying those activities that aggravates pain, sometimes even stopping them completely.

We use equipment’s such as LASER, Ultrasound, bracing, taping, hot and cold applications, further we have a strong bias towards manual therapy especially focusing on the myofascial system. The goal here is to decrease the pain and get the person comfortable.

As the pain decreases, we want to simultaneously build the strength, mobility and agility to be able to accomplish those activities. We select the right exercises appropriate with the current levels of strength and mobility and gradually progress them to meet the demands of the activities. 

Our ability to do things that we love doing is what defines our “quality of life”.

Once we accomplish the goals, we emphasize on following the exercises and the ergonomic strategies to prevent the injury from happening again. It is important to “get well” but equally important to “move well”.

There are certain complicated situations associated with chronic pain, where things do not flow as simple as described above. More about that in future articles.