The Evidence Against Passive-Only Models

Key Points:

1. Passive interventions may offer short-term relief—but do not address root causes.

• Techniques like massage, manipulation, needling, or modalities (e.g., TENS, ultrasound) can reduce symptoms temporarily, but do not restore function or movement patterns.
• Long-term outcomes are best when patients engage in active retraining, as reliance on passive care alone can hinder recovery.

2. Passive-only care promotes dependency and disempowerment.

• Patients may believe they need to be "fixed" and need ongoing hands-on treatment.
• This reinforces fear-avoidance behaviors.
• Language like "your pelvis is out" or "this needs to be put back" increases fear and reduces autonomy.

3. Active care shows stronger long-term outcomes.

• Exercise, education, and movement retraining outperform passive therapies in most musculoskeletal conditions, especially low back and neck pain.
• Active care builds capacity, improves tissue tolerance, and enhances self-management skills.

4. Clinical guidelines discourage passive-only approaches.

• Most international guidelines emphasize active interventions as the primary approach, with passive care recommended only as a complement.

References

1. Hayden, J. A., van Tulder, M. W., Malmivaara, A., & Koes, B. W. (2005). Exercise therapy for treatment of non‐specific low back pain. Cochrane Database of Systematic Reviews, (3), CD000335. https://doi.org/10.1002/14651858.CD000335.pub2
2. O’Keeffe, M., Purtill, H., Kennedy, N., Conneely, M., Hurley, J., O’Sullivan, P., & Dankaerts, W. (2016). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. Cochrane Database of Systematic Reviews, (4), CD000963. https://doi.org/10.1002/14651858.CD000963.pub3
3. Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The effectiveness of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 32(5), 332–355. https://doi.org/10.1080/09593985.2016.1194646
4. Darlow, B., Fullen, B. M., Dean, S., Hurley, D. A., Baxter, G. D., & Dowell, A. (2013). The association between health care professional attitudes and beliefs and the attitudes and beliefs of patients with low back pain: A systematic review. European Journal of Pain, 16(1), 3–17. https://doi.org/10.1016/j.ejpain.2011.06.006
5. Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & Clinical Guidelines Committee of the American College of Physicians. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367
6. National Institute for Health and Care Excellence (NICE). (2020). Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59]. https://www.nice.org.uk/guidance/ng59
7. Bennell, K. L., Hunter, D. J., & Hinman, R. S. (2015). Exercise and osteoarthritis: cause and effects. Comprehensive Physiology, 5(2), 829–864. https://doi.org/10.1002/cphy.c140015
8. Hodges, P. W., & Tucker, K. (2011). Moving differently in pain: A new theory to explain the adaptation to pain. Pain, 152(3 Suppl), S90–S98. https://doi.org/10.1016/j.pain.2010.10.020

Disclaimer:

This course, created by Eric Hammer, Registered Physiotherapist, is designed for licensed physiotherapists and rehabilitation professionals for educational purposes only. It does not provide individualized medical advice and should not replace clinical judgment. Participants are responsible for applying the material within the scope of their professional practice and regulatory standards. Eric Hammer assumes no liability for injury or damages arising from use of course content.

All course materials are the intellectual property of Eric Hammer and may not be copied, shared, or redistributed without permission.