If you’ve ever been sidelined by pain or injury, chances are you’ve asked yourself: how can I speed up my recovery and prevent injuries like this from happening in the future? I’ve asked these questions too. Having broken five bones and had multiple surgeries myself, I’ve spent a fair amount of time on both sides of the treatment table. And I’m willing to bet that, like many, you’ve already tried resting, using ice or heat, massage, or even pain medications. So why is it then that you’re still feeling stuck?

This lack of progress you’re facing is not due to effort levels. It’s more likely due to the fact that you’ve received a ton of advice that sounds helpful but doesn’t actually move the needle. Most people rely heavily on passive treatments and not enough on active ones. This article will highlight active versus passive treatments for injury, as well as discuss the important differences between the two.

 

Passive Treatment

Following any injury, there can be a lot of uncertainty regarding next steps. You have options to try and self-manage, find answers online, consult with friends and family, or seek professional help. Even though most of the information we come across is well-intentioned, we have been conditioned as a society to follow many rehab principles that aren’t necessarily supported by evidence anymore. Most of these principles relate to waiting for your body to heal itself through limiting movement and relying on things like medications, time off, creams, massage, etc. These are all passive treatments where something is being done to you, rather than you actively engaging in the recovery process.

Let’s walk through some of the most common passive treatments and their potential benefits when used appropriately. After all, there is nothing wrong with using these treatments when they are used alongside a movement-based rehab plan. With that being said, let’s dive into these treatment methods.

Rest or Time Off

Following an injury, the tendency is to want to stop everything. Stop your usual activities. Stop working out. Stop moving. It’s human nature to want to avoid pain at all costs and “protect” our bodies from further damage. This is a survival technique and it’s normal. This can be effective during the initial period following an injury, but it can also quickly become harmful if we take too much time off. 

So the next question is how much rest is too much rest? The initial healing phase is 2-4 days. During this time, it is appropriate to temporarily reduce your activity levels and allow the body to begin to heal itself. Inflammation is the body’s way of starting the healing process after an injury. When you get hurt, more blood flows to the area, causing redness and swelling. This swelling can make it harder to move and use the injured tissue. At the same time, your body sends in special cells to clean up the damage and begin the repair. The problem is, once we get past these initial 2-4 days, if you still aren’t moving, your body’s tissue may start to lose flexibility and strength. Rest, itself is not rehab. Once the first few days pass, movement becomes medicine.

 

 READ: WHAT TO KNOW ABOUT TISSUE HEALING TIMELINES

 

Ice and Heat

One of the most common questions I get from patients is “Should I be using ice or heat to treat my injuries?” Neither is necessarily superior to the other, but it is important to think about the timing of use for each.

 

 

If you are going to use heat, doing so in the morning or before activity can aid in warming up muscle tissues and preparing them for light exercise or movement. This is why taking a warm shower can oftentimes feel like a great way to start the day, especially when you are in pain.

 

 

Ice or cold compression, on the other hand, is best used after activity or when tissue is irritated or inflamed. Some inflammation is necessary to allow the body to heal, but if the inflammation is chronic (more than 3 months), you might start to try and use some ice to calm things down (3).

 

 READ: ICE AND REST: WHY TO AVOID THIS AFTER SURGERY

Pain Medication

Sometimes, pain is so high that it feels like it is preventing any movement at all. In these cases, a short-term dose of pain medication can lower your sensitivity just enough to start moving again. But here’s the key: it should support movement, rather than replace it. Pain meds should never be the end solution, but rather a stepping stone toward getting active again. When pain medications are used in isolation, they initially are very powerful. However, over time, your body builds up a tolerance to them. This means that the once effective dose no longer has the same effect and you are left taking more and more medication and getting less and less relief. We want to avoid this at all costs. After all, your goal shouldn’t just be pain relief, it should be a functional recovery where you are able to make a full return to your pre-injury levels of activity. If you have any further questions about pain medications, be sure to consult with your care team.

 

Massage

I work with a lot of patients who are experiencing physical therapy for the first time. Many of them are expecting to receive a lot of hands-on care in the form of soft tissue work, including massage. This is one of the components many are most looking forward to, and who can blame them? Massage feels good, and it can definitely help relax tight muscles and promote short-term relief. However, it is most effective when paired with movement. The way massage works is by temporarily “distracting” your nervous system and reducing pain signals going to the brain. That doesn’t necessarily mean it’s healing the injury. It just opens a short window where movement might feel more manageable. Use that window to move (1).

 

 READ: MASSAGE: WHERE DOES IT FALL IN THE RECOVERY PROCESS?

 

By now, you should be able to start to see some of the trends in terms of when passive treatment is appropriate and how to best utilize it. These forms of treatment can be used to help get you over the initial hump and jumpstart your recovery while managing your symptoms, as you begin moving more and rebuilding strength once again. 

 

Active Treatment

Now that we’ve gone over the more familiar passive methods of recovery after an injury, let’s talk about what actually works when it comes to getting you back on track: active treatment. Active treatment means you’re doing the work. You might be guided by a physical therapist or other medical provider, but it’s your effort that drives the recovery. You’re not just lying on a table while something’s being done to you, you’re participating in your own comeback.

Next, we’ll go over some of the most effective active treatments and their potential benefits.

 

 

Strength Training

When you’re dealing with pain or injury, lifting weights or resistance training might seem like the last thing you should be doing. Won’t that make things worse? Actually, no. In most cases, applying the right amount of stress to the injured tissue helps speed up healing. The key is how much and how often. One of the main principles to understand here is known as progressive overload. This is the idea that you need to gradually increase the challenge your tissues face over time to build strength, resilience, and confidence in the injured area. This may be as simple as performing seated heel raises or other body weight exercises shortly after experiencing an ankle sprain.

 

Found in Week 4 of our Ankle Sprain Rehab program on the Prehab App 

 

You may have heard of the phrase, “No pain. No gain.” When it comes to strength training and rehab, this does not apply. The goal is not to increase discomfort in the area, but rather to improve your tissues ability to tolerate  movement through larger ranges, while gradually improving strength. Read more about progressive overload in the blog below!

 

 READ: THE KEY TO PROGRESSIVE OVERLOAD

 

Mobility Work

Aside from strength training, another major contributor to pain is limited mobility. We talked earlier about the tendency to rest and stop moving when injured. When this goes on beyond the initial inflammatory phase, reducing or avoiding movement can lead to a loss of range of motion over time. And the longer you wait to move, the harder it becomes to regain that motion and the more discomfort you’re likely to feel. That’s why it’s so important to keep your joints moving, even if your current ranges of motion limited. Gentle, consistent movement helps preserve mobility and supports long-term recovery (2).

 

Learn more about the science behind improving your mobility here!

LISTEN: HOW MUCH SHOULD WE STRETCH?

Neuromuscular Re-Education (NMR)

Following injury, there is often a disconnect between the brain and the injured area. This could be anything from the pain receptors’ responses to movements to things like balance and performing certain movements smoothly. When there is decreased neuromuscular control, there is also increased risk of re-injury. The best way to improve is to perform slow controlled movements you are struggling with to work on control and timing of movements. This may often include single-leg movements and balance exercises, but of course depends on the specifics of the injury as well.

Find in Week 4 Ankle Sprain Prehab program on the Prehab App

 

Closing Thoughts

If you are stuck in your rehab or recovery, think about some of the things you have tried up until this point. You can even make a list. Once you finish your mental or physical list, ask yourself if each of the things you have tried has been a passive treatment or an active one. If your recovery has been rooted in mostly passive treatments, start exploring some more active options. In most cases, you’ll be pleasantly surprised at how well your body responds to exercise in as little as just a few weeks when incorporated in the right way.

If you need more ideas or structure to start actively taking control of your rehab, check out our programs on the prehab app.

References:

1. Mak S, Allen J, Begashaw M, Miake-Lye I, Beroes-Severin J, De Vries G, Lawson E, Shekelle PG. Use of Massage Therapy for Pain, 2018-2023: A Systematic Review. JAMA Netw Open. 2024 Jul 1;7(7):e2422259. doi: 10.1001/jamanetworkopen.2024.22259. PMID: 39008297; PMCID: PMC11250267.
2. Tse MM, Wan VT, Ho SS. Physical exercise: does it help in relieving pain and increasing mobility among older adults with chronic pain? J Clin Nurs. 2011 Mar;20(5-6):635-44. doi: 10.1111/j.1365-2702.2010.03548.x. PMID: 21320192.
3. Wang ZR, Ni GX. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? World J Clin Cases. 2021 Jun 16;9(17):4116-4122. doi: 10.12998/wjcc.v9.i17.4116. PMID: 34141774; PMCID: PMC8173427.

 

About The Author

John Schaefer PT, DPT, OCS, CSCS

[P]rehab Writer & Content Creator

John is a native of Rochester, MN and a double graduate of Saint Louis University, where he studied marketing and exercise science before earning his DPT.

Always up for an adventure, John traveled to Boston following graduation to intern at Champion PT and Performance. There he was able to work with high-level high school, college, and professional athletes. Following this experience, he headed south to pursue orthopedic residency training in Houston, TX at Harris Health System, working with a largely underserved and non-English speaking population.

John’s treatment philosophy hinges on empowering movement through extensive education and easy-to-replicate exercises, as well as meeting patients where they are. This perspective is shaped by his personal experiences, including five broken bones and two surgeries, during a multi-sport childhood filled with lots of activity and adventure.

Outside of work, you can find John cycling, attending concerts/festivals, hiking, and traveling!

Follow along on instagram @johnschaefer.dpt

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.