**Two things physiotherapists and patients should know**

1. Do not employ passive physical agents for chronic pain conditions. Instead, encourage participation in an active treatment program:

There is limited evidence for use of passive physical agents to obtain clinically important outcomes for musculoskeletal conditions.

A carefully designed active treatment plan has a greater impact on pain, mobility, function and quality of life.

While there is some evidence of short-term pain relief for certain physical agents, there is emerging evidence that passive physical agents can harm patients.

Communicating to patients that passive, instead of active, management strategies are advisable exacerbates fears and anxiety that many patients have about being physically active when in pain, which can prolong recovery, increase costs and increase the risk of exposure to invasive and costly interventions such as injections or surgery.

Evidence suggests that passive treatments are only useful if used to facilitate participation in active treatment.

2. Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals:

Improved strength in older adults is associated with improved health, quality of life and functional capacity, and with a reduced risk of falls. 
Older adults are often prescribed low dose exercise and physical activity that are physiologically inadequate to increase gains in muscle strength.

Failure to establish accurate baseline levels of strength limits the adequacy of the strength training dosage and progression, and thus limits the benefits of the training.

A carefully developed and individualized strength training program may have significant health benefits for older adults.


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