Passive Vs. Active Care for Low Back Pain in Lifters

This week, let’s walk through the stages of treatment for low back pain and how we use passive AND active care to address our exam findings. First, let’s discuss the differences in “passive” and “active” care. Passive care is treatment that is done to the patient or client. This would be things like chiropractic adjustments, most soft tissue work, cupping, instrument assisted soft tissue mobilization, joint distraction, and dry needling. Active care requires the patient to complete a task. Examples are corrective exercise, performance exercise, active soft tissue mobilization, breathing drills, and other movement specific therapy.

Passive care for low back pain

In cases of low back pain, both passive and active care is often necessary. The spectrum of how much focus is placed on the different treatment types though varies. With acute and especially painful cases of low back pain, maybe from disc herniations, severe muscle strains, ligamentous sprains, or nerve entrapment, low level active care is often used with extensive passive care during early stages of treatment. Here is an example of passive care treatment for low back (lumbar spine) spinal mobility, which could also be used for pain tolerance.

Beginning active care for low back pain patients

The priority shifts from pain control and tolerance to more long-term goals, such as addressing the true root cause issues. This priority shift can only happen after we have gained the ability to create motion and movements without unwanted compensation due to pain. Once we are addressing more functional and long-term goals, we increase the amount of active care treatment. The progressions range from working to improve orientation (think things like anterior pelvic tilt and rib flare), to specific and precise muscle activation and mobility. Look below for examples of active care exercises for these goals in low back patients.

Integrating active mobility into muscle activation and strength

Middle stages of care will use active care that focuses on integrating the above goals, like mobility, orientation, and muscle activation with movement strategies and stability. What this means for the low back pain patient is we might try to integrate a more neutral pelvic positioning with core stability and glute activation. By creating a more neutral position we take pressure off the low back in movements like a squat or deadlift (think butt wink). But, we need to be able control these positions under load. So, we can work on core stability and glute strength/ activation with movements seen below.

Integrating mobility and strength into new motor patterns for low back pain patients

The last stages of active care will focus more on the goals or activities of the lifter. Whether a golfer or a CrossFitter, we can tailor the late-stage care towards these activities. For weight room activities that we need low back pain patients to get back to doing, we can work towards the back squat, deadlift, and thruster. To do this, we often have to work in integrating our stabilizing strategy into these core movements. This means using the mobility, muscle activation, stability, and strength to create improved motor control with appropriate bracing. Check out these articles to learn more on this…

Conclusion

Specific and individualized passive AND active care are both critical for low back pain lifters. We need to be able to use both, with changing emphasis, throughout a treatment plan. Missing one component can result in getting stuck or stagnant in your improvement. Even worse, you might start to feel better without addressing the long-term, root cause issues that will result in a future injury, potentially worse than before. If you have recurring or on and off low back pain, getting comprehensive examination AND treatment is vital to stopping the pattern.

-Dr. Nick DC, TPI, CSCS

If you would like to learn more about your body, pain, and performance, send Dr. Nick an email at contact@integratedrpc.com or call at (585)478-4379, or schedule a FREE discovery visit at Contact.

Instagram @Integrated.Rehab.Performance