So, once the chiropractor has helped to resolve the presenting pain or problem, is ongoing chiropractic maintenance care a good idea, or is it a waste of time and money? The latest research gives some insights.
When a new patient walks into my rooms they bring with them an issue they’d like my help with. Often it is a pain in their frame, a “this isn’t working like I think it should” problem or a postural bad habit they’d like to shift. If it is a problem I think can be managed better by a different kind of practitioner then I’ll refer them to someone I know can help. If it is an issue I can help with we implement a short trial of conservative spinal care to establish whether it is the best strategy. With measured and significant progress in the right direction we proceed with care until we achieve the patient’s set goal ~ whether that’s being pain free or able to walk with their pelvis in the neutral posture or having achieved a physical goal (like run a half marathon or being able to babysit the grandkids) without falling apart. It’s wonderful to help people achieve those goals!
At this point we have another conversation regarding how to proceed with care moving forward. Do we let things go until the person has an issue they would like me to help them with again or do they enter into maintenance care?
It’s important to acknowledge here that “Best Practice” is defined as where scientific evidence, practitioner experience and patient choice come together. We need good data so we can make good choices, and how care proceeds is always the patient’s choice. There is also no wrong choice. It’s totally up to the individual, and changing one’s mind is okay too! It’s the patient’s body, they get to choose what to do with it 
Another definition of quality health care is clarified by Roy Steiner here ~
So, once the chiropractic care has helped to resolve the presenting pain or problem, is ongoing chiropractic maintenance care (CMC ~ regular adjustments to the spine and frame throughout the year irrespective of whether the person is experiencing symptoms at the time) a good idea or is it a waste of time and money? It may be a blunt question, but it’s what people wonder at this stage of care. It’s a good question.
There was a series of very relevant studies performed by Dr Andreas Eklund and his team across the last six years looking at CMC(2,3,4,5) . Specifically, they explored:
Initially Eklund et. al. took 328 patients who had come to the end of their initial intensive chiropractic care and achieved their goals. They divided these 328 individuals into a control group (who then saw their chiropractor only when they experienced symptoms), and a group who received CMC (regular chiropractic care at a frequency decided according to the condition and the patient’s needs). Across the following year the scientists collected data via text messaging regarding “how many days of bothersome low back pain” the subjects had experienced each week. In that year 16,692 texts were exchanged and the team received a 98.9% response rate from the people participating in the study (which is pretty awesome). The resulting data showed that:
In terms of cost, as there is only an average of two extra treatments per year when partaking of the maintenance care option, the cost is neutral or minimal from a patient perspective; and from a societal perspective there is a cost saving (as the person is spending less time compromised by their pain and unable to contribute to society).
In terms of pain and debility? 30 less days of pain per year sounds great whether you usually experience less than 30 days of pain per year (in which case you might have no days of “bothersome” pain through the year!) and also great if you live with chronic pain, where taking the edge off the pain or a pain free day is gold. Ten more pain free weeks per year at the average cost of two extra chiro visits each year? Sounds like a good deal to me.
So who, what kind of person, benefits most from CMC?
Once a person has regained good function of their frame it behooves them to sustain this condition with exercise and self-management tools (i.e. all the tips the chiro gives to the individual across their intensive care period). It does take some self-discipline and requires an investment of time and energy in the individual’s own physical and mental wellbeing. A certain kind of person will take this on and run with it, consequently managing their spinal health themselves and not needing the CMC.
Sometimes all the good habits in the world still don’t meet the body’s needs. This happens when there are other concomitant health issues or where a person is living a life where the requirements the person is demanding of themselves exceed the resources (physical, mental, emotional) they have on hand. In this scenario CMC can help bridge the gap and keep those bodies on an even keel.
Sometimes a person can’t or won’t do the things they know will keep their bodies running better and in that case CMC can bridge the gap and keep their bodies running well.
The other place where CMC is really valuable is for people who experience chronic pain. Chronic pain is defined as pain that persists beyond the time it takes for the tissues to heal, or beyond three months from onset (read more here). It can be constant or intermittent and episodic. For a person living with chronic pain anything that can take the edge off their pain or decrease the intensity and frequency of their pain is gold. Eklund et. al. established the following with in the latest research they published in 2020:
CMC is an excellent addition to the strategies used to manage chronic pain.
So, according to the research, what does CMC look like? Patients choose CMC to “prevent recurrent pain, keep optimal function and stay pain free.” At an appointment for CMC a person will receive gentle spinal manipulative therapy specific to their needs and coaching on appropriate exercise and lifestyle matters to optimise the function of their frame (6).
How often should a body be adjusted when they are receiving maintenance care? That’s a “how long is a piece of string?” kind of question. It truly depends on the body, its current level of function and what the world is throwing at the person at that moment in time. Each person is different and frequency of care varies through their life. Statistically speaking, the frequency of CMC occurs at an interval of between 2 weeks and 3 months with 2 months being the average (6,7).
CMC is an option once a person has achieved their initial goals with their chiropractic care. It is always the patient’s choice. Give us a call at the Adelaide Chiropractic Centre on 08 8221 6262 to discuss your health goals and how we can keep your frame working the best it can.
