When it comes to injuries that people sustain, few have as great an impact as back injuries. When someone suffers a back injury - whether it's a minor injury involving muscle strain that slows you down for a short period of time or a more serious, life-altering spinal cord injury - recovery is often slow. In part, this is because there's more to recovering from a back injury than simply allowing it time to heal.

Back injuries, because they have such a tremendous impact on a person's whole life - there's not just the pain of the injury, but also there are emotional frustrations that come from being less able to get around and, in the event of major back injuries, there's a psychological impact of a life-altering injury that must be overcome. In all cases, in order to make progress in recovering from a back injury, it's essential for the patient to let go of the emotional and psychological impact - and to work through the frustrations that arise; that is the only way that the patient can fully focus his or her attention on recovering from the injury.

Of course, the first step in recovering from a back injury is to ensure that the injury has been diagnosed properly. A proper diagnosis is essential because it determines the course of treatment for the injury. Unlike a sprained ankle in which therapies are more or less universal, back injuries can be made worse if the wrong course of treatment is followed. The pain from a back injury will continue and may even get worse if an inaccurate diagnosis is made and the wrong course of treatment is taken; this not only means that the patient will suffer through the pain for a longer period of time, but it also means that there's an increasing chance that the pain will be something that stays with the patient throughout his or her life.

Depending on the diagnosis and cause of the back pain, a number of different treatment options may be considered. While in some cases surgery may be necessary, it is often a treatment plan of last resort. Physical therapy and exercise are often necessary; ultrasound therapies and electrotherapy may be used as might massage which will help to alleviate the tension in the muscles and improve circulation. Heat treatments are often used to loosen tense and tight muscles and ice packs as well as steroidal injections are used to reduce swelling.

In addition to the above physical therapies, many patients find a benefit from hypnotherapy - a guided pain reduction process - as well as psychotherapy which, in many cases is advisable when the back injury is severe and life-altering. For different injuries, for different individuals, it's important to recognize that different therapies will be more effective than others. It is essential that the injury is properly diagnosed in order to choose the right course of treatment; however it's also important to understand that more than one therapy may need to be tried in order to find the one that is most effective.

When you first sprain your ankle, strain your knee or hurt your rotator cuff, most of the therapy that you receive will be passive; recovering from that injury, however, will in many cases require active therapy as well. Is one necessarily better than the other? Can you have both? And, oh yeah, what's the difference anyway?

Passive therapy gets its name because the treatment of the injury doesn't require forcing the body to work through. Instead, passive therapy includes using heat packs to loosen the muscles and ice packs to help to reduce swelling. In some cases, long term injuries like back pain are treated simply by alternating heat and ice at the location of the pain. In other cases additional therapies are used.

Iontophoresis is a passive therapy in which a steroid cream is applied to the skin and electrical current is applied to the area; the steroids are absorbed through the skin and reduce swelling around the injury. Ultrasound heating can be used as can TENS – transcutaneous electrical nerve stimulation. With TENS, a low level electrical current is used to override the signal of pain through the nervous system.

Active therapy, on the other hand, involves the patient who is recovering from illness, injury or even surgery taking on a more active role in the process of healing. A combination of some massage techniques as well as targeted exercises serve to help rebuild the muscle, increase strength and improve the range of motion in the area around the injury.

Often, a combination of passive and active therapies are used in order to help with recovery. For example, heat may be applied to the area of the injury to loosen the muscles and make it more comfortable for the patient to follow through the exercises suggested by the physical therapist; icing may take place at the end of the session so that the work that was done becomes less likely to cause more stiffness or swelling.

Similarly, TENS or iontophoresis or ultrasound treatments may be used, especially if the patient is experiencing an increased amount of pain or tightness, or if a new degree of active therapy is to be started. The combination of active and passive therapies – along with, in some cases, massage and manipulation of the area in order to increase the amount of oxygen reaching the cells – can be beneficial to a patient's recovery.

What most people who are recovering from an injury are likely to discover is that, yes, active and passive therapies are often used in conjunction with one another. For minor injuries and for pain management, passive therapies are often enough. For more serious injuries, however, a physical therapist should be consulted to determine the appropriate course of action: passive therapies may be all that are recommended, active therapies may be suggested or the therapist may call for a combination of the two.

Ultimately, each injury is different. Each person who is recovering from an injury will respond differently to treatment. An educated health care provider or physical therapist can evaluate the situation and choose the right course for your needs.