If you read out blog regularly, you’ll know that we strive to be a person-oriented, but data-driven clinic. Speak to almost any chiropractic patient, and they’ll tell you that maintenance care can have a huge impact in terms of reducing back pain flare-ups – but a new study has now confirmed that this is the case.
What is maintenance care?
When you first visit a chiropractor (at least in the vast majority of cases) it will be because you’re in some kind of pain. While we’d love to see people as a preventative measure before you’re unable to live your life normally, we all understand that it’s not until something has become an issue that most of us find the time to take care of it. During the initial phase of treatment, you might visit the clinic a few times a week while your painful symptoms are reduced. Once symptoms have been reduced from an acute state to a more manageable one, care tends to proceed once or twice a week (more often if you prefer) until you are no longer suffering from pain. At Complete Chiropractic, we also offer a third stage of treatment designed to correct postural issues which – if addressed, can go a long way to preventing another painful episode. However far along this continuum you want to go, eventually you will reach a point where weekly care is no longer necessary – this is where maintenance care comes in.
Maintenance care is essentially ongoing chiropractic care which seeks to prevent your original complaint from flaring up again while optimising posture and performance. Maintenance care usually includes spinal manipulation, some form of exercise or stretching prescription, and specific advice tailored to your circumstances – whereas pain treatment is designed to address your specific problem, maintenance care is designed to be your personalised long term safeguard. The optimum frequency of maintenance care depends on your goals, budget and timeframe, but many people find a happy medium with one adjustment once a month or so.
As a Chiropractic Biophysics clinic, Complete Chiropractic also offers more than most when it comes to maintenance centre – through techniques such as the mirror image approach, we also help our patients to optimise factors such as their posture and gait. These tweaks and improvements reduce the risk of further problems, but can also improve your overall quality of life – many of our clients also experience improvements in areas such as overall health and fitness and sports performance
Does maintenance care work?
We’re often asked if maintenance care is worthwhile – and this is a fair question – once you’re out of pain, do you still need to visit the chiropractor? It’s important to understand that the purpose of maintenance care is not to treat pain, but rather to stop it coming back (and, at Complete Chiropractic, to improve your overall posture and quality of life!). Maintenance care helps to address the gap which exists between how we all should look after our spines, and how much we can actually do, given our work and life commitments. Chiropractic clients report time and time again that maintenance care helps any future painful issues remain as “low level” complaints, or allows them to be avoided entirely – but what does the science show?
For quite some time, there was a lack of large scale research investigating the issue of maintenance care, but recently there have been a number of useful studies. A 2018 study[1] considered a large sample of 328 participants with a view to establishing how effective maintenance care is. The group of patients selected for the trial ranged from 18 to 65 years old and had all suffered from non-specific low back pain – all had also had an early favourable response to chiropractic care. After an initial course of treatment, eligible subjects were assigned to either a maintenance care group or a control group.
The study sought to establish the total number of days with bothersome LBP that each patient experienced within 52 weeks.
The results of the study were clear – maintenance care resulted in a reduction in the total number of days per week with bothersome LBP compared with the control group. During the 12-month study period, the MC group reported 12.8 fewer days in total with bothersome LBP compared to the control group. The study, therefore, concluded that maintenance care is an effective way to help prevent low back pain from reoccurring.
New study : Maintenance care
Following this, a 2020 study[2] has now shown that chiropractic patients had fewer days with bothersome (activity-limiting) low back pain (LBP) when receiving maintenance care – compared to receiving treatment only with a new episode of LBP.
A secondary analysis of data from a randomized controlled trial of 319 patients seeking chiropractic care for recurrent or persistent LBP used 52 weekly estimates of days with bothersome (activity-limiting) LBP. Interestingly, this study also looked at the pain trajectory – that is to say, how bad the pain was on any given day – associated with a painful episode.
The data showed that patients receiving maintenance care had flat pain trajectories (which is to say their pain was stable and lower) around each new treatment period and reported fewer days with pain. This compared favourably to patients without maintenance care, who showed higher pain overall as well as a higher peak and reduction in pain. In the below graph the blue line represents the non-maintenance group, whereas the green shows the clients receiving maintenance care. Enough said!!
[1] Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, et al. (2018) The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back painÐA pragmatic randomized controlled trial. PLoS ONE 13(9):e0203029. https://doi.org/10.1371/journal.pone.0203029
[2] Andreas Eklund, Jan Hagberg, Irene Jensen, Charlotte Leboeuf-Yde, Alice Kongsted, Peter Lövgren, Mattias Jonsson, Jakob Petersen-Klingberg, Christian Calvert & Iben Axén, The Nordic Maintenance Care Program: Maintenance Care Reduces the Number of Days With Pain in Acute Episodes and Increases the Length of Pain Free Periods for Dysfunctional Patients With Recurrent and Persistent Low Back Pain – A Secondary Analysis of a Pragmatic Randomized Controlled Tial Chiropractic & Manual Therapies 2020 (Apr 21); 28: 19
