You’ve probably heard it from every chiropractor, physio, and sports therapist under the sun:

“Don’t forget your rehab exercises!”

And if you’ve ever left a clinic with a neatly printed sheet of stretches and strengthening drills, you might have wondered — why does everyone push rehab so hard? Isn’t hands-on treatment enough?

The short answer: passive care (like manual therapy, dry needling, or joint mobilisation) can calm things down — but rehab is what keeps them that way.

Let’s dive into the “why” behind it all.

Passive Care: The Calm Before the (Re)Build

Passive treatment is any therapy where you’re, well, passive — the clinician does the work. This might include spinal adjustments, massage, dry needling, or shockwave therapy. These approaches can reduce pain, ease muscle tension, and improve movement in the short term .

But pain relief is only step one.

When you’ve sprained an ankle, strained your lower back, or tweaked your neck after a long week at the desk, the body naturally compensates — other muscles switch on to “protect” the injured area, sometimes creating a chain reaction of tension and imbalance .

If you only treat the pain without retraining the stabilisers and movers, the problem often returns. That’s where rehabilitation comes in.

The Stabilisation Stage: Re-Teaching the Basics

After an injury, especially to the spine, shoulder, or ankle, deep stabilising muscles can “switch off” — not from laziness, but from the body’s protective reflexes .

For example:

• After a lower back strain, the multifidus (a deep spinal stabiliser) often shows decreased activation, even after pain has subsided .
• Following an ankle sprain, the peroneal muscles can become inhibited, affecting balance and control .

Rehab exercises at this stage are gentle and focused — think pelvic tilts, deep core activation, or balance drills. The goal is not to sweat, but to reconnect.

This phase lays the foundation for more advanced strengthening later. Without it, any return to sport or daily activity can feel wobbly — literally.

Once the stabilisers are back online, the next phase is activation and strengthening.
These exercises bridge the gap between injury rehab and real-world function.

Why this matters:
When muscles are activated in the right sequence, movement becomes more efficient and less painful . That’s why your physio might cue you to “engage your glutes” before you squat, or to “set your shoulder blades” before you lift.

Examples include:

• Shoulder impingement: moving from gentle rotator cuff activation to controlled resistance training can restore normal shoulder mechanics .
• Knee pain (patellofemoral syndrome): targeted hip and quadriceps strengthening improves alignment and reduces load on the knee .

By gradually reloading tissues, you’re not just recovering — you’re future-proofing your body against re-injury.

When Exercise Isn’t the Right Call (Yet)

Of course, there are times when exercise isn’t appropriate — at least not right away.

In cases of acute inflammation, fractures, or severe nerve compression, rest and passive treatment take priority . The body needs time to calm down before we can safely ask it to move.

Even with something as common as an acute low back flare-up, the first step might be gentle movement or pain modulation, not lunges and planks.

But here’s the key point: this pause is temporary. Once the pain settles and tissues begin to heal, guided movement helps accelerate recovery and prevent long-term weakness or stiffness .

So, when we say “exercise is medicine,” we don’t mean “do it no matter what” — we mean “do the right kind, at the righttime.”

Curiously Aligned Take

Passive care is the spark. Rehab is the fuel.

The combination of hands-on treatment plus exercise is what leads to lasting change — less pain, more mobility, and greater resilience in the long run.

So the next time your clinician tells you to do your rehab exercises, just remember:
They’re not being pushy — they’re helping you move from pain relief to real recovery.

Your body deserves that full journey.

---

References

1. Bialosky, J. E. et al. (2018). The mechanisms of manual therapy in musculoskeletal pain: A comprehensive model. Manual Therapy, 23(1), 1–11.
2. Coulter, I. D. et al. (2019). Chiropractic care and outcomes for low back pain: A systematic review. Spine Journal, 19(6), 953–968.
3. Hodges, P. W., & Tucker, K. (2011). Moving differently in pain: A new theory to explain altered movement in pain. Pain, 152(3 Suppl), S90–S98.
4. Panjabi, M. M. (2010). The stabilizing system of the spine: Function, dysfunction, adaptation, and enhancement. Journal of Spinal Disorders & Techniques, 5(4), 383–389.
5. Freeman, M. D. et al. (2017). Paraspinal muscle dysfunction in low back pain: A review. Pain Physician, 20(3), 205–218.
6. Wikstrom, E. A. & Hubbard-Turner, T. (2017). Ankle instability: Implications for balance, gait, and injury recurrence. Sports Medicine, 47(4), 667–677.
7. Behm, D. G. & Chaouachi, A. (2011). A review of the acute effects of static and dynamic stretching on performance. European Journal of Applied Physiology, 111(11), 2633–2651.
8. Littlewood, C. et al. (2019). Exercise for rotator cuff tendinopathy: A systematic review and meta-analysis. British Journal of Sports Medicine, 53(6), 370–377.
9. Lack, S. et al. (2015). The relationship between hip strength and pain in patellofemoral pain syndrome: A systematic review. British Journal of Sports Medicine, 49(14), 881–888.
10. Bleakley, C. M. et al. (2012). The PRICE concept revisited: Protection, rest, ice, compression, and elevation should be updated to POLICE. British Journal of Sports Medicine, 46(4), 220–221.
11. Arienti, C. et al. (2020). Effectiveness of exercise therapy in musculoskeletal disorders: A systematic umbrella review. Annals of Physical and Rehabilitation Medicine, 63(6), 485–493.