There’s a question I’ve been asked throughout my career, and it usually comes from practitioners early in their training: should you start with passive care or active care?
My answer has evolved over the years, but my current position is clear: active care should be the foundation, and passive care should support it — not the other way around.
Here’s why. Passive interventions — adjustments, manual therapy, massage — provide relief. They address immediate dysfunction. And they’re valuable. But they don’t teach the patient’s neuromuscular system to maintain the correction. The moment the patient leaves the office, their habitual motor patterns take over, and the body drifts back toward the dysfunction that brought them in.
Active care — structured exercise, motor control training, postural rehabilitation — builds the patient’s capacity to hold the correction on their own. It strengthens the weak links. It retrains the movement patterns. And critically, it develops the interoceptive awareness needed to recognize when they’re drifting.
I didn’t realize this 20 years ago, but that’s why the StrongPosture® protocols deliver great results. Coupling a hierarchy of systematic, progressive active core to whole body engagement, functionally tailored to the person gives patients ownership of their outcomes. Passive interventions facilitate the process, as does common-sense biomechanical education and self-care that works.
This isn’t just philosophical. The evidence supports it. A 2025 Lancet Rheumatology review confirmed that exercise-based approaches produce lasting results for chronic low back pain. The active component is what makes rehabilitation durable- especially when guided by a pro. For practitioners interested in the clinical sequencing of active and passive care, I explored this on PosturePractice.com: What Comes First: Active or Passive Care?