What is active versus passive treatments? Is active recovery truly superior?

I think people like to romanticise passive therapies because they have been around for thousands of years. Beyond that, they also make us feel really, really good. So, we want to believe that it works.

When it comes to the practitioner’s side, it makes sense to do what you are familiar with and to do what people love. Afterall, change always comes with a steep learning curve.

satisifed patients newspaper
As a Missouri clinical instructor told me Patients can be very satisfied and dead an hour later Sometimes hearing bad news is not going to result in a satisfied patient yet the patient could be a well informed prepared patient

And it’s always easier to get people to give you money if you just do what they like. It’s kinda like how good customer service increases sales but doesn’t necessarily give you good recovery outcomes.

What is an active recovery?

comic of chiropractor
Most peoples feedback for spinal manipulation is that the results dont last Yet when offered with a more long term pain solution they tend to avoid it entirely

Most people think active recovery = exercises. That’s somewhat true but not entirely accurate.

Active recovery refers to anything that requires the patient to put in the hard work so they can reap the rewards from your own hard work.

Exercise counts. Mindfulness practice counts. Making small lifestyle adjustments count. Sleep early counts.

These can all be considered active recovery.

Passive care refers to treatments where things are done to you without you having to do anything yourself.

Chiropractic adjustments, massages, acupuncture all count.

Why is active care superior to passive treatments?

old woman kettlebell
Just because you are old or unfit or very injured doesnt mean exercise cannot help you Lets not forget that patients post surgery after their muscles and joints have been brutally mangled with do have to go through exercise therapy

Because research says so. A lot of research has been published to show that passive treatments don’t really do better than sham.

It’s not that people don’t feel better after a chiropractic adjustment. It’s that your improvement in pain or function after receiving an adjustment is as good as if you received a fake one.

Because of this, passive care is often referred to as low value care.

Because, you don’t really get much out of it besides feeling really, really good. This good feeling, however, is transient. When measured in a laboratory setting, it can last as short as 30 minutes.

What if you combined both? Is it better?

Not really.

Studies have shown that adding spinal manipulation to exercise does not improve pain or disability — even in the short-term!

A lot of practitioners like to say manual therapy can provide pain relief that works as a window of opportunity for patients to get exercising. But when the window is only 30 minutes long, and that you are going to be sore again after exercising, it’s really not very meaningful.

Furthermore, the same temporary pain relief that comes with traditional hands-on treatments can be replicated with isometric exercises.

There is no winning argument to using passive treatments in clinical practice!

Chronic pain is more than just a pain experience.

chronic pain flowchart
Manual therapy is no more than a feel good treatment that has no real effects on the body Some claim to help with spinal misalignment muscle knots or adhesions However these have been debunked by research as junk science

Exercise and active recovery strategies allow you to address more than just pain relief.

For example, getting a senior patient who had back pain to deadlift 40kg is ridiculously empowering.

Pushing yourself to do more than what you would usually do challenges the misconceptions you may have about your own body.

Weak and fragile? No.

Robust and adaptable? Yes.

It also gives you a sense of control over your own pain. When you are in bed all day because of your pain, you become a victim to your pain experience. You are helpless until your next chiropractic treatment.

Being able to exercise safely even though you still have some pain shows you that you have control over your life. In that even though it hurts a little, it doesn’t mean you are damaged or more injured, but that you are helping yourself to recover.

Furthermore, regular exercise comes with all sorts of benefits including improved mood and better sleep. Being able to develop an exercise routine for yourself is a behaviour change that will set you up for long-term success.

If you want long-term results, you need active recovery.

manual therapy recovery model
Looks compelling but honestly doesnt work Theres hardly any research to suggest that hands on treatment is better than placebo While patients love it the numbers dont lie

There are some suggestions that a hybrid model may work better. Best of both worlds, right? No.

That was actually the model I adopted when I first started Square One Chiropractic (which quickly rebranded to Square One Active Recovery).

It was SUPER clear since the beginning that people were taking too long to get better. The money was good though. But at what cost?

Would you want to feel good for just a couple of days then have your pain come back?

Sure, it could be a very manageable niggling that you can tolerate, and it’s WAY better than what it used to be. I hear you.

But why settle for that when you can have better results with exercise?

Exercise works for you. Period.

80 year old man with sciatica
Age is just a number You can be 80 and be fit and pain free

If you have back pain or neck pain and you are not ready to give exercise a shot, that’s fine. Take your time to figure it out. In the meantime, chiropractic adjustments and massages can be a great interim relief.

If you are worried that exercise is too much for you, or that you are too far gone for exercise to help, that’s 100% not the case. We have cases of patients with severe knee arthritis benefiting from heavy weightlifting.

We have 80 year old patients who are told that surgery is the only option recovering from their sciatica through exercises.

There’s no other way to say this: exercise will work the best for you.


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.