Good question. Maintenance and wellness care is almost exclusively associated with chiropractic care. Chiropractors use the no-quick-fix argument to support repeated chiropractic visits and selling massive packages. But what does research say? You may be surprised.

Chiropractic symptomatic vs. maintenance care

To start, it is good to understand the differences between symptomatic and maintenance care.

In symptomatic care, patients are treated based on their symptoms. This means you come in with pain somewhere in your body, your chiropractor uses chiropractic adjustments or a variety of treatment options to get you out of pain. Once your symptoms are gone, you are discharged from care. It is also referred to as sick care (i.e. the care you get when you are sick).

In maintenance care, however, patients are usually committed to a long-term care plan. This means patients regularly receives chiropractic adjustments, soft tissue therapy, stretching, and exercises even after their symptoms have resolved. The interval between visits can be as short as one week to a month. The treatment you received will largely based on what the chiropractor finds. For example, the chiropractor may decide you have some joint restrictions and proceed to perform a chiropractic adjustment. Maybe they think you have “tight” muscles and will use soft tissue techniques to “release” them. Maintenance care is also referred to as wellness care. Because you are still under care despite being well.

p.s. chiropractors (or physiotherapists or massage therapists) CANNOT accurately determined if your vertebra is out of place. We briefly mentioned this in Four Things Your Chiropractor Doesn’t Want You To Know.

Most chiropractors believe maintenance care visits can prevent future pain episodes through optimisation of spinal function. However, there is no agreement on the frequency of treatments required to achieve this.

Reference: The Nordic Maintenance Care Program – An interview study on the use of maintenance care in a selected group of Danish chiropractors

What is the recommended “dose” of chiropractic adjustments?

Due to the sparse research, we don’t really know for sure. To date, there are two trials that had looked into this.

The first study looking at dose-response relationship for chiropractic care and low back pain was published in 2004. That specific paper found that low back pain sufferer who saw a chiropractor three to four times over a 3-week period experienced more pain relief than those who only went once or twice. In short, patients who went to the chiropractor nine or 12 times fared better than those who went only three or six times.

A second randomised controlled trial was published in 2014 and it compared four doses of care – no treatment, 6, 12, or 18 sessions of chiropractic adjustments. The paper found that 12 sessions over a six week period yielded the best improvement for both pain and functional impairment.

From what we know (as of today), 12 sessions seems like the magic number – way less than the 40-session packages Singapore chiropractors seem to be peddling!

Read: How Much Does It Cost To See A Chiropractor In Singapore

It should be noted that these studies did not offer a combination treatment group. Perhaps exercise WITH chiropractic adjustments could lead to shorter recovery times? After all, we do know exercise is first-line treatment when it comes to low back pain.

Does Maintenance Care Prevent Pain?

We are getting closer to our answer! We now know 12 sessions of chiropractic adjustments alone (no exercise, no dry needling) over 6 weeks gives you the best outcome – regardless of when or if your pain resolves before the end of the 12 sessions by the way. What happens to you if you continue regular chiropractic adjustments AFTER the initial care phase? Do you get even better results?

Maybe.

There are two studies that attempted to address just that.

Research Supporting Regular Chiropractic Adjustments

A 2011 study published in Spine (one of the world’s most prestigious journals) separated sixty patients into three groups. First group received 12 sham spinal manipulation (think placebo) over 1 month, the second group received 12 treatments of spinal manipulation over 1 month, and the third group received 12 spinal manipulations over a month followed by maintenance spinal manipulation every two weeks for nine months.

Chiropractic adjustments and spinal manipulation are considered to be synonyms.

Results? The third group (12 sessions of spinal manipulation plus maintenance spinal manipulation every two weeks) had more improvement in pain and disability scores at the end of ten months.

Research Supporting Regular Chiropractic Visits

A bigger, higher quality paper (328 patients) published just this year found that patients who have undergone maintenance care experienced 13 fewer days of bothersome low back pain compared to the control group. The average total number of chiropractic visits (over a year) in the maintenance group patients was just under nine! Pretty neat huh?

It should be note that in this study, patients received predominantly chiropractic adjustments but also other therapies including soft tissue therapy and exercise advice!

How Often Should I See A Chiropractor?

Seeing a chiropractor regularly for as little as once every month (1.5 months to be exact) can significantly improve your long-term pain outcomes. While there is some research to support higher frequency of chiropractic treatments, more research needs to done to determine their cost-effectiveness.

How often should you see a chiropractor? We can’t be entirely sure. For now.

Further readings: The Nordic maintenance care program: the clinical use of identified indications for preventive care