Let’s say you’re a patient of ours or another clinic. You presented with low back pain and limited activities on your very first visit and now you’re about done with your treatment plan. Now your pain is basically gone and you no longer have any limitations. You are living your normal life and working out without any issue. Great! You’re done with “active” care. But should you keep coming once a month or so? Is there any benefit to continued treatment?
Active vs. Maintenance Care
Before we dive deep into this conversation let’s first define a few things. The term “active” care is used when treatment is being used to treat an “active” complaint. If you currently have low back pain and are getting treated, you are in “active” care. If you keep coming back once the back pain is gone, that is considered “maintenance” care. This maintenance care is for “maintaining” your current status of little to no pain, not working on an “active” painful issue.
Generally, in our office, once a patient achieves the goals that they laid out on the first visit (i.e. pain level of 1/10, sit for one hour without low back pain, etc.), we leave it up to the patient if they want to continue with chiropractic maintenance care. Usually, that entails a visit every month or so. These visits can kind of be considered “tune-ups” for the body. Probably about 25% of our patients decide to get these “tune-ups.” The other 75% just give us a call if their pain returns (hopefully it doesn’t!). But, should 100% of people get monthly tune-ups? Or is it a waste of time and money? Let’s look at some recent research.
In a 2018 study, 328 patients with low back pain were treated with chiropractic care. This treatment included manipulation, mobilizations, and muscle/soft-tissue work. The average pain level was ~5.2/10, and after six visits the pain levels dropped to an average of ~2/10. At this point, the patients were split into two groups. The first group of patients received “maintenance” care over the next 52 weeks at regular intervals. These intervals were determined by the clinician’s judgment and ranged from every few weeks to every month or two. The second group of patients were dismissed from care and were told to return when their symptoms returned (treat-as-needed group).
At the end of the year, they looked at two things. First, which group had more days with bothersome low back pain and second, which group had more office visits. The results? The group that underwent maintenance care had approximately 13 fewer days of bothersome low back pain in the year! Surprisingly, the maintenance group only had an average of 1.7 more office visits during the year compared to the treat-as-needed group. Basically, the treat-as-needed group usually re-aggravated their pain, so they needed to return for active care for a few visits. This is why the difference between total visits wasn’t that large.
Last Words on Maintenance Care
So is chiropractic maintenance care worth it? Well, that’s up to you. An almost two-week difference in days with bothersome pain between the two groups is a big change though. Also, the difference in visits was only a little less than two treatments in one year. So time-wise, there’s not a big difference there.
An important factor to note is that these treatments only involved joint manipulation and soft tissue treatment. It didn’t include any exercise therapy. I would like to guess that if a good exercise program (such as McKenzie and functional rehabilitation) was a part of every patient’s treatment plans, recurrences of pain would have been much lower and this would have made a big difference in the results. Oh well, maybe next study.
Another thing we need to mention. Insurance does not cover “maintenance” care. Why? Basically insurance wants you to get treated for an active issue. If your pain went away, they aren’t going to keep paying for a visit every few weeks or months. Hopefully, with more studies like this one, they will change their tune, but for now, maintenance care falls under cash rates. Yeah, it sucks.
I hope this helps when you are making your decision on chiropractic maintenance care! If you need to schedule with us, you may do so online by clicking HERE.
Jeff Remsburg DC MS DACRB Cert MDT