Maintenance Chiropractic: Does the research support it or vilify it?

Maintenance chiropractic care: does the research support it or does the research vilify it? That is our topic of the day. And right off the bat, I would love to know if you prescribe or recommend maintenance care in your practice?

Maintenance chiropractic care has been around a long time, and there's always been, in my opinion, some questions regarding the criteria for it. Does it help people or does it not? And to date, there has been very scant research that looked at it in any capacity whatsoever.

But we were very fortunate in the year 2011 SPINE, the esteemed top-tier research journal, took a look at maintenance care.

So SPINE published a fascinating paper. The paper is titled "Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome." Again I'll say that one more time in 2011s SPINE put out a research paper titled "Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome".

I'm going to read a couple of quotes from the study that I believe to be very important and start to tell the story. The researchers found "nonspecific low back pain represents about 85 percent of low back pain patients seen in a primary care center and about 10 percent will go on to develop chronic disabling low back pain". So they just kind of setting the stage. 

We know historically, through The Evidence Based Chiropractor, 30% of a primary care doctors daily volume of patients are a spine or musculoskeletal patient. What they're saying is nonspecific low back pain represents about 85 percent of those individuals. What they're also saying is about 10 percent will go on to develop chronic disabling low back pain chronic pain over three months of course. 

Now the researchers also touch on something else that has chiropractors I think we could find very interesting. The researchers also found  "the postulated modes of action of manipulation include disruption of articular adhesions, improvement of trunk mobility, relaxation of hypertonic muscle by sudden stretching, the release of entrapped synovial folds, attenuation of Alph motor neuron activity, and enhancement of proprioceptive behavior and the release of beta-endorphins." This gets down to the mechanism of action on a chiropractic adjustment.

The third quote that I want to bring up from this paper is compelling. The researchers found "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." 

Let me say that one more time. The researchers at SPINE concluded, "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." 

I'll tell you I've practiced in multiple multi-disciplinary clinics where I've interacted with orthopedic surgeons, neurosurgeons, physiatrist's you name it, day in and day out. And one thing that I will say is that over the last ten years I've noticed that, from a surgical perspective, a lot of the docs do have an understanding that spine related complaints are a result of long-term deterioration and degenerative changes with microtrauma throughout an extended period of time. 

Many times when people end up in the surgery realm or in the interventional realm they have degenerative processes and changes that have taken a long long time to get there. And what I have seen and found over the last 10 years is that MD's and DO's are more open than ever to the fact that these are ongoing processes. So if you, as a chiropractor, are doing the right thing to encourage the person to stay active and to increase segmental mobility. You know they're going to continue to live on planet Earth, gravity is going to continue to take its toll. But when you can do some things periodically to help that patient stay as active as possible, that's a huge win. 

At The Evidence Based Chiropractor, a lot of what we focus on is the research and building relationships with other healthcare providers from a relationship standpoint. No surgeon is excited to "go back in" on a patient with repeat surgeries. There is a law of diminishing returns with surgery. That is an understatement. So it's an essential for us, as chiropractors, to be able to articulate what the research has showcased regarding maintenance care. Now that doesn't mean you see the person one time every day for the rest of their lives. Don't get me wrong. Everybody is different. 

Think about 90% of people experiencing spine pain in their life, that's significant. And 10% of those individuals potentially going on to develop chronic disabling pain that often results in surgery. Well, its reassuring to know chiropractic care has the potential to break that cycle. 

Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?