Maintenance Treatment

One of the concerns many people have regarding chiropractic treatment is the concept of maintenance care. Some people are afraid to initiate chiropractic treatment for fear that, "once you go, you have to go forever." On the other hand, many people who have been helped want to maintain their progress and are confused that their insurance will not pay for their treatment. So, where does truth lie?

For many years, when discussing maintenance treatment, chiropractors would use parallels to other areas of life to demonstrate that maintenance care is not isolated to chiropractic treatment. Certainly your dentist doesn't expect to see you once and then never again. Orthodontists highly recommend retainers for several years after using braces. How many medications can you stop taking after they've achieved their goal? Even a brand-new car has a thick book telling you how maintain it at regular intervals. In other words, maintenance is a normal part of our everyday lives.

Two studies seem to give credibility to these metaphors. The first was published in 2004 in the chiropractic Journal of Manipulative and Physiological Therapeutics (JMPT), and the other was published in 2011 in the medical journal Spine. Both studies sought to determine the benefit of maintenance treatment for low back pain by testing for three things.

  1. Either a mock adjustment or a waiting period was used to determine if the problem would resolve on its own.
  2. Each participant was treated for low back pain with adjustments for 12 visits over four weeks.
  3. After four weeks of treatment, each of these groups was subdivided in to two groups: one that received no additional treatment, but was re-evaluated periodically, and another that received maintenance treatment every three weeks (JMPT) or every two weeks (Spine) for a nine month period.

Both studies showed that maintenance treatment sustained the benefits of the initial treatment, and that the pain, or the limitations to lifestyle caused by the pain, would return if the progress was not maintained.

In other words, maintenance treatment had a long-term benefit.

So, why isn't maintenance treatment covered by insurance companies? I'm not sure. Not to be cynical, but research rarely modifies behavior, at least not quickly. I guess we're back to analogies on this one. An insurance company doesn't pay for a gym membership or healthy food from the grocery store, even though these are important choices you make for your overall health and actually help control healthcare costs. For those who choose maintenance treatment, it's a good choice for their overall health; it's just not a covered service. Do we bill an insurance company and then "wait and see if they will pay?" No. Non-covered means non-covered and we honor that. For those who chose maintenance treatment, they pay for the service and their insurance company is not involved.

Does maintenance treatment have to be every two or four weeks? No. Those were the parameters the studies used. The time between visits varies according to the patient. In my office, after patients go through their treatment plan, they are released. If they chose maintenance treatment, then additional visits are spread out over time until the joints show signs of poor motion or their activities are again affected. This lets us know how long that particular patient can go between treatments. Typically this is somewhere between 3-12 weeks.

Practically, do I think that everyone needs maintenance care? Not necessarily. When most patients come to the office, they are in pain and usually have some lifestyle limitations imposed by the pain. As the research showed, by the end of their course of treatment they are no longer hurting and are usually able to return to their normal, active lifestyle. From there, it depends on the person. If a person has a healthy spine, makes healthy choices on things like weight, nutrition and exercise and doesn't demand a lot from his or her body physically, then maintenance care may not be very beneficial to him or her. On the other hand, if someone has a lot of damage or degeneration in the spine, hasn't made all the best health choices (not all of us do), and has a job or activity that strains them physically, then maintenance treatment is often very beneficial. In other words, it depends on the patient and his or her needs.

Is maintenance right for you? Hopefully you have enough information to decide on your own. If it's an option you wish to pursue, let us know and we'll help you the best way we can.


Does maintained Spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome? Spine (Phila Pa 1976). 2011 Jan 17. [Epub ahead of print]

Efficacy of Preventive Spinal Manipulation for Chronic Low-Back Pain and Related Disabilities: A Preliminary Study J Manipulative Physiol Ther. 2004 OCT; 27(8) pp. 509-15