Active Care: Understanding the Role of Movement in Recovery

Whether you're dealing with an injury, chronic pain, or just a general sense of non-optimal health, the path to recovery is often best when it involves multiple approaches to care. While passive treatments - like chiropractic adjustments - can provide immediate relief and structural corrections, research increasingly shows that combining passive and active care together leads to superior outcomes.

Understanding Active vs. Passive Care

Passive Care involves treatments where the patient receives care without active participation. The treatment is done to you.

Examples include:

• Chiropractic adjustments

• Massage therapy

• Acupuncture

• Ultrasound therapy

• Electrical stimulation

Active Care requires patient participation. The treatment is done by you

Examples include:

• Therapeutic exercises

• Stretching routines

• Strength training

• Balance exercises

• Movement pattern correction

The Science Behind Combined Care

Research consistently demonstrates that combining active and passive care yields superior results compared to either approach alone. A 2018 systematic review published in the Journal of Manual & Manipulative Therapy found that patients receiving both spinal manipulation and exercise showed greater improvements in pain and function compared to those receiving only manipulation.

The effectiveness of this combined approach can be attributed to several factors:

1. Neurological Adaptation: Passive care, such as chiropractic adjustments, creates immediate changes in joint mobility and nervous system function, providing a window of opportunity for active care to reinforce these changes.

2. Tissue Remodeling: While passive care can restore proper alignment and reduce restrictions, active care ensures that tissues adapt and strengthen in these new, correct patterns.

3. Motor Control Development: The combination allows patients to learn and reinforce proper movement patterns during the period of reduced pain and improved mobility.

Why Chiropractic Adjustments Alone May Not Be Sufficient

While chiropractic care provides many valuable benefits, the adjustment by itself is a type of passive care. Passive care alone without active care can lead to:

• Dependency on passive treatments

• Slower development of tissue strength and stability

• Limited improvement in functional capacity

• More frequent episodes of symptom recurrence

Functional Assessments - Measure How You Move

Functional assessments are evaluations that measure how well you can perform fundamental movement patterns essential for daily living. They are used to evaluate your body as an integrated system by measuring strength, balance, coordination, and mobility in real-world contexts. Healthcare providers use these assessments not only to diagnose current issues but also to predict and prevent future problems.

The beauty of functional assessments lies in their accessibility and practicality. You don't need to wait until you're injured or experiencing pain to begin monitoring your functional capacity. By regularly performing these simple tests at home, you can track your physical capabilities. Armed with this knowledge, you can identify areas needing improvement and take proactive steps to enhance your overall function.

Individuals who regularly monitor and maintain their functional fitness experience fewer injuries, recover more quickly when injuries do occur, and maintain their independence longer as they age. Moreover, these assessments can serve as motivational tools, providing concrete metrics for improvement and helping you set realistic fitness goals.

Functional Assessment Benchmarks

Here are some of the most popular functional assessments you can perform at home.

1. Single-Leg Stand (SLS) Test

2. Floor Transfer Test

3. Basic Squat Test

4. Forward Bend Test

   
   

Before performing any self-assessment, ensure you have safe surroundings including a non-slippery standing surface, a wall or chair nearby for safety, and someone nearby for help if needed. Warm up by walking in place for a minute or two. Warming up decreases the risk of injury from performing these assessments.

Use a mirror, recording device, or friend/family member to evaluate your results.

Single-Leg Stand Test

Stand with your feet hip-width apart. Lift one foot about 6 inches off the ground. Start the timer when your foot leaves the ground and stop it when you lose your balance and have to touch the wall or floor. Perform on both sides.

Benchmark by Age Group

• 20-39 years old: 45+ seconds

• 40-49 years old: 41+ seconds

• 50-59 years old: 37+ seconds

• 60-69 years old: 27+ seconds

• 70+ years old: 15+ seconds

Implications of Poor Performance:

• Increased fall risk (2.1x higher in older adults scoring below age norms)

• Potential vestibular dysfunction

• Reduced proprioception

• Core stability deficits

• Possible peripheral neuropathy

Action Steps:

• Begin with supported balance training

• Address ankle stability

• Incorporate visual tracking exercises

• Progress to dynamic balance activities

Floor Transfer Test

Lower yourself to a seated position on the floor. Once seated, return to standing, trying to complete both movements without using your hands. If you need to use hands, note how many times you needed support.

Benchmark by Age Group

• Ages 20-59: Should be able to complete with minimal difficulty

• Ages 60+: Ability to complete correlates with reduced mortality risk

Implications of Poor Performance:

• Reduced overall strength-to-weight ratio

• Compromised functional independence

• Higher mortality risk in older adults

• Limited hip and ankle mobility

Action Steps:

• Start with assisted transfers

• Build lower body strength through progressive loading

• Improve hip hinge patterns

• Address mobility restrictions

Basic Squat Test

Start with your feet shoulder-width apart and arms extended forward for counterbalance. Initiate the movement by pushing your hips back (like sitting in a chair). Keep your chest up and lower until thighs are parallel to ground (if possible). Push through your heels to return to standing

Benchmarks for proper squatting:

• Feet remain flat

• Knees track with feet

• Thighs reach parallel to ground

• Torso remains relatively upright

• Heels stay planted

Implications of Poor Performance:

• Increased risk of lower back injury

• Compromised hip mobility

• Potential knee tracking issues

• Reduced functional capacity for daily activities

• Core stability deficits

Action Steps:

• Begin with supported squats

• Address ankle mobility restrictions

• Strengthen hip stabilizers

• Improve motor control patterns

Forward Bend Test

 To perform this test, start by standing with feet hip-width apart, knees straight but not locked, and arms relaxed at sides. Slowly bend forward from your hips keeping your legs straight, but not locked. Allow your arms to hang down and note where you fingertips stop. Slowly and carefully return to an upright position.

Benchmark by Age Group:

• Ages 20-39: Touch palms to floor

• Ages 40-59: Touch fingertips to floor

• Ages 60+: Reach past mid-shin

Implications of Poor Performance:

• Increased risk of lower back injury

• Hamstring inflexibility

• Potential neural tension issues

• Restricted fascial mobility

• Possible sacroiliac joint dysfunction

Action Steps:

• Implement daily mobility work

• Address neural tension through specific stretches

• Progress gradually with hamstring lengthening

• Incorporate fascial release techniques

Implementing an Active Care Program

To maximize the benefits of chiropractic care, consider incorporating these active care elements:

1. Daily Movement Practice: This can include activities such as a few minutes of mobility work, basic strength exercises, aerobic exercise, and/or balance training

2. Progressive Loading: Start with body weight exercises and gradually increase resistance as strength and control improve.

3. Functional Pattern Training: Here are the top functional movements we use on a day-to-day basis. Focusing on these movements can help improve your ability to do them when required to do so in real-life situations.

• Squatting

• Hinging

• Pushing/pulling

• Rotating

• Single-leg balance

  
  

Monitoring Progress

Grab a notebook and track your progress using these simple metrics:

1. Functional Capacity

• Regular reassessment of benchmark tests

• Activity tolerance

• Quality of movement

2. Pain Levels

• Frequency (how many times a day or week)

• Intensity (pain scale 0-10)

• Duration (how long does the pain last)

3. Independence Levels

• Reduced dependency on passive care

• Increased confidence in self-management

• Improved daily function

Conclusion

While chiropractic care and other forms of passive treatment provide valuable benefits on their own, the effectiveness of these treatments is significantly enhanced when combined with active care strategies. The key to long-term success lies in transitioning from passive reliance to active participation in the healing process. By incorporating both approaches, patients can achieve better outcomes and maintain their improvements over time.

Remember that these benchmarks serve as general guidelines, and individual variations are normal. Always consult with healthcare providers before starting a new exercise program, and progress gradually based on your current abilities and limitations.

References

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