How many sessions should I have with a chiropractor

Chronic pain is notoriously difficult to treat. When treatments start to fail, a lot of people with chronic pain in Singapore turn to chiropractic in hopes that it could do better.

Today, we will discuss the research behind chiropractic adjustments as a potential solution for your own pain, as well as the number of sessions you should have for best recovery outcomes.

Does chiropractic adjustments work?

Before we talk about how many sessions of chiropractic treatment you need, we need to discuss if adjustments even work. Honestly, there is very little evidence to suggest chiropractic adjustments work. This is not limited to spinal manipulation but pretty much all passive modalities. So, massage, IASTM, passive stretching, dry needling, etc. They are now all broadly grouped under low value care.

It is not that people don’t feel better after these treatments. They do. But the improvement in symptoms may not be coming from the treatment themselves.

Research has been suggesting that chiropractic adjustments DO NOT WORK – not even temporarily. In a study by chiropractor Sasha Aspinall, participants who received spinal manipulation have improved responses to pain compared to those who received sham adjustments. In other words, it’s very possible that the relief people experience from adjustments are purely placebo in nature.

Again, I want to emphasise that people do feel better. However, the improvement is not coming from the adjustment itself. Even based on people’s personal experiences, the relief is also often short-term so it’s really not a good treatment modality.

This is why virtually all clinical practice guidelines put spinal manipulation as second-line treatment. Exercise, across all updated guidelines, is first-line treatment for virtually all chronic pain.

How often should I go to a chiropractor for maintenance?

Beyond the acute pain episode, many patients are advised to keep coming back after their pain has subsided. Many chiropractic clinics sell this as a spinal tune up, so you can keep your spine in a tip top condition.

Personally, I don’t subscribe to that. The last time I got adjusted by a chiropractor was probably in 2018. I also have had spinal manipulations done here and there as part of massages. That’s about it.

Research wise, there is some truth to that maintenance adjustments can be better than no adjustments. In 2011, a study looked at the benefits of regular spinal adjustments. The results showed that participants who had regular spinal manipulations (i.e., every 2 weeks) had better pain and disability scores than those who did not.

A 2018 study also reported similar findings. Participants who had undergone maintenance chiropractic care experienced 13 fewer days of bothersome low back pain. The average total number of chiropractic visits (over a year) in the maintenance group patients was just under nine! Pretty neat huh?

If you are thinking you need regular chiropractic sessions to help with your lower back pain, there is some research to say that it does. However, you shouldn’t be going for it more than once every fortnight.

Can you ever stop going to the chiropractor?

One of the greatest fears of seeing a chiropractor is that you would have to keep going once you start. This is particularly true in Singapore because many clinics here tend to see big packages that are 40 to 80 sessions. In order for them to make another sale off you (i.e., more revenue), they would need you to complete your sessions ASAP.

Needless to say, this create a dependency dynamics where you feel reliant on your chiropractor. Perhaps, there is even some fear of stopping. You are worried that if you stop, everything will start to worsen again.

If that is the chiropractor you are seeing, then it will be more challenging to stop. First, you are used to having regular adjustments and that’s what your mind and body has adapted to. Second, the chiropractor probably has done nothing to help you work towards not having to come back.

In order to stop depending on endless chiropractic adjustments, you will need to work with someone who can help you find freedom from pain. This is what we do at Square One Active Recovery. We focus on helping our clients help themselves manage their own condition. Our end goal is to make ourselves redundant to our clients.

What happens if you stop chiropractic adjustments?

Your pain and/or symptoms may return. As simple as that.

This is not always just a physical phenomenon. There is also a strong psychological aspect to it as well. Try asking someone who cracks their knuckles non-stop, all day, everyday. They are going to feel miserable. Not only that, they probably will struggle to stop ask well.

It’s almost like an addiction.

The pleasantness associating with cracking knuckles is no correlated to any physical health matrix. Like, manipulating them doesn’t actually make your knuckles any healthier than if you don’t crack them. Similarly, ceasing to crack them don’t make your joint health deteriorate – even if you feel like crap!

Depending on how often you are getting adjusted, there’s a very high chance you would feel worse once you stop your chiropractic sessions. However, that doesn’t always mean that your condition is worsening.

P. S., All cervical manipulation also comes with a small but real risk of stroke. Joanna Kowalczyk died after seeing a chiropractor because no one knew about the tears in her arteries. She got adjusted on four different occasions and the fourth one eventually led to her death.

How do I stop going to the chiropractor?

I would highly recommend asking your chiropractor for a exit plan. Like, what do I need to do so I can stop coming to you. Your chiropractor should be able to give you a loose timeline on what you need to achieve and what are the steps you can take to get there.

If your chiropractor cannot do both, it’s time to make a switch. Find a chiropractor or a health coach who can get you there.

Self-management requires subject matter expertise

To a large extent, being healthy is not intuitive. This much I can agree. For example, 40% of people in Singapore are either overweight or obese. Burnout is a growing concern in Singapore, with 61% of employees reporting feelings of burnout. We are clearly no good at managing our own health. We all can do with extra help in improving our health.

With this in mind, it’s a good idea to work with a health coach or chiropractor who does health coaching. Solution-focused coaching is something we do offer at Square One Active Recovery. In fact, I wrote the chapter on chronic pain in Solution Focused Coaching in Asia.

I know coaching can sound fluffy but it’s not without merit. Health coaching is already being used in mainstream medical care to promote behavioural change. For example, National University Hospital runs a 6-week Chronic Disease Self Management Programme. As part of the programme, participants can expect to learn about symptom management, nutrition and exercise, relaxation techniques, decision-making skills, etc. This is very much similar to what we use to help our clients help themselves find freedom from pain.

Health is not just an absence of disease

I talk a lot about taking an holistic approach. A lot of people misunderstand holistic to mean conservative treatment or that all our body parts are connected to each other (i.e., integrative). This is largely inaccurate.

Holistic, the way we do it at Square One Active Recovery, is to take a bird’s eye view of what it means to be healthy, and what are the different strategies we can take to improve your health. In doing so, we aim for your pain to improve and not come back (cos you are healthier).

Health is a complete state of physical, mental, and social well-being. Not just an absence of disease. Making your pain or symptoms go away, alone, will not make you healthy. And your symptoms are likely to return.

Long-term results come with a radical shift in your health status. This will mean behaviour changes that involve taking on health habits, which could be exercising more or even exercising less. It could also be a healthier body weight or a more balanced lifestyle.