What Comes First Active or Passive Care?

“What comes first, active or passive care?”  

It’s a question often asked by doctors and therapists who incorporate StrongPosture® as a foundational base for more traditional rehab. If you teach a hands-on BAM* framework integrated with other rehab, or you’re using the 7 Steps to StrongPosture® HEP (Home Exercise Program including motor control exercise) along with, or supported by in-office care, my answer is the same.

It depends…

As a doctor of chiropractic my preference is to start with pain relief focused passive care. The feedback I receive from other DCs tends towards spinal and extremity manipulation first, along with targeted muscle therapy as indicated. The rationale is that unlocking segmental motion allows a person to retrain and recruit different motion patterns when learning the new stabilization patterns of strengthening posture.

Diagnostic and Therapeutic

When fascial adhesions and/or other mechanical restrictions are lessened or removed, accessing subtleties of motion with StrongPosture® protocols becomes more possible. The value of MUST vs TRY cueing is that when precisely taught, it is both diagnostic to observe previously neglected motions, as well as actively therapeutic by recruiting neglected muscle fibers and the controlling neurologic pathways.

Especially when there’s a spinal issue, properly applied segmental manipulation can stimulate facet capsule and fascial proprioception, and recruit neglected muscle fibers controlling reflexive balance. Shifting the proprioception towards greater accuracy can propagate up and down the kinetic chain, which in turn and again, makes it easier to find previously forgotten subtleties of movement and posture.

An Opportunity to Individualize Your Care

For my colleagues in other professions using StrongPosture® BAM protocols, I find it’s more of a 50-50 proposition. Some physical therapists, massage therapists and trainers subscribe to the passive therapy first school of thought. Others use the BAM MUST vs TRY cueing to observe, assess and target areas to cue in other motor control exercises, or as a target for other passive therapies.

Bottom line. I’ve tried it both ways in many combinations. It comes down to the individual. At the end of the day it’s about helping the person by building personal agency through stronger posture consciousness.

PosturePractice Tip:

Create more engaging experiences by trying it both ways.

• Here’s what Visit #1 looks like:
  “Today, first we’re going to do (fill in your passive therapy of choice), then we’ll do your StrongPosture® work). Next time we’ll try it the other way. Pay attention so we can see what works best for your body”.
• Here’s what Visit #2 looks like:
  Reverse the order.
• Here’s what Visit #3 looks like:
  Assess progress yourself, and then ask the patient which seemed to work best for their unique body.

Try it over the next month and let me know what you find works best.