The Truth About Maintenance Chiropractic Care

When it comes to chiropractic care, patients usually take one of two approaches. The first approach is known as symptom-based care. The purpose of this course of treatment is to decrease and eliminate your pain to get you back to doing the things you love. Once the discomfort is gone, treatment is discontinued until another episode of pain occurs and the patient seeks chiropractic care again. (Think of your car: Warning lights appear on your dashboard or your tire gets a hole, you bring your car to your mechanic, and they fix the problem. You return only when another warning light appears, you hear rattling, or something breaks.)

The second approach is when the patient chooses to continue with routine chiropractic care after their pain is gone and the symptom has been resolved. People typically call these periodic check-ups maintenance or wellness care. You can think of this routine check-up, like a doctor’s visit or routine dental cleanings. These check-ups are important because they can detect problems and fix them (usually with fewer visits) before they result in pain and become an issue that affects certain aspects of your life. Often, a joint is restricted, muscles are tight, or range of motion is reduced long before a person experiences pain. These musculoskeletal “tune-ups” help prevent future episodes of pain and help keep you well. Pain is the last symptom to appear when something is wrong, but it is also the first symptom to go away on your road to recovery. (Think of your car: Regular oil changes keep your car functioning the way it needs to, but it also provides an opportunity for your mechanic to do a check-up and assess your car's performance. Maybe you have a small leak in a hose that goes to your transmission. You might not notice the leak, but your mechanic will catch this problem during your regular oil change and fix it before it leads to a major issue with your transmission. I have yet to meet a mechanic who doesn’t encourage regular oil changes and routine maintenance checks).

"I feel fine and can do everything during a regular day without any problems. Why do I care?"

I’m glad you asked. As I mentioned above, pain is the last symptom to appear when there is a problem. It's that warning light on your car telling you to get help soon or it won't be able to function properly anymore. Routine check-ups are a great way to prevent pain and problems from happening. Re-read the second paragraph.  

We can look at this another way too--how the adjustment actually works and performance improvement. Have you hit a plateau in your training and don't know why? "The postulated modes of action of (spinal) manipulation (aka adjustment) include disruption of articular adhesions, improvement of trunk mobility, relaxation of hypertonic muscle by sudden stretching, the release of entrapped synovial folds, attenuation of Alpha motor neuron activity, and enhancement of proprioceptive behavior and the release of beta-endorphins."³  What that fancy lingo means is that an adjustment improves flexibility, movement, nerve function, and blood flow. This allows your muscles and joints to move better, improving performance. Even if you don't experience pain, chiropractic adjustments may help you run a little faster, jump a little higher, make your golf swing smoother, improve your balance, or allow you to set a new max.⁴  Routine care helps detect and fix any hitch in your giddy-up.

"Is there proof that maintenance chiropractic is actually better than symptom-based care?"

YES, there have been numerous studies comparing symptom-guided treatment (SGT) and chiropractic maintenance care (MC). One study concluded “maintenance care was more effective than symptom-guided treatment in reducing the total number of days in 52 weeks of bothersome non-specific low back pain”.² During a 12-month period, the MC group reported 12.8 fewer days (almost 2 weeks less!) of low back pain, compared to SGT.² SPINE Journal recommends that maintenance (at a frequency of 2x month) adjustments to the spine may prevent future episodes of back pain and states "as patients did benefit from the maintenance treatments we believe that periodic patient visits permit proper evaluation, detection, and early treatment of an emerging problem, thus preventing future episodes of low back pain.”³ A third study evaluated work-related low back pain and compared recurrence rate among maintenance care provided by chiropractors, physical therapists, and physicians. The study found that patients who saw a chiropractor for routine MC had the lowest recurrence of low back pain. Patients who saw physical therapists or their primary care physicians for MC had more episodes of recurring low back pain.¹

These are just a few or the many studies highlighting the effectiveness of chiropractic and maintenance care. The SPINE Journal recommends maintenance care at a frequency of 2x/month, but not everyone requires that frequency. For some, a tune-up adjustment every 4 weeks, or even every couple months works just fine. Ultimately, the decision between symptom-guided care and continued chiropractic check-ups is yours to make. Low back pain (and musculoskeletal pain in general) is one of the most common and costly healthcare problems and is the leading cause of limitation and work absence in the world—if you could prevent low back pain from happening to you, would you?

References

1. Cifuentes M, Willetts J, Wasiak R. “Health maintenance care in work-related low back pain and its association with disability recurrence.” J Occup Env Med. 2011 Apr; 53(4):396-404. doi: 10.1097/JOM.0b013e31820f3863

2. Eklund A, Jensen I, et al. “The Nordic maintenance care program: effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—a pragmatic randomized controlled trial.” 2018 Sept 12. https://doi.org/10.1371/journal.pone.0203029

3. Senna MK, Machaly SA. “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” Spine (Phila PA 1976). 2011 Aug 15; 36(18):1427-37. doi: 10.1097/BRS.0b013e3181f5dfe0.

4. Costa S. "Effect of spinal manipulative therapy with stretching compared with stretching alone on full-swing performance of golf players: a randomized pilot trial." J Chiro Med. 2009 Dec; 8(4):165-170. doi: 10.1016/j/jcm.2009.06.002.