Maintenance Care

Why should I see my Chiropractor for Maintenance Care?

Let me ask you this, why should you go to the Chiropractor in the first place? Well because of all the traumas, accidents, whiplash injuries, stress, muscle tensions that pull on bones, the birthing process, falls and toxins that we experience in a life time.

Even though you see your Chiropractor for back or neck pain, there is a good chance that the problem has been there for years without you knowing it. Muscles and ligaments that surround your joints and hold you together adapt amazingly to allow you to keep going. Nevertheless, at some point in your life, you will pick up a sheet of paper from the ground, look back in your car or simply wake up with terrible aches and pain.

Why? Well it didn’t happen over night! See, the body has a tremendous ability to forgive until you reach a maximum point of adaptability and your brain decides to stop you from hurting yourself any longer.

That’s when your Chiropractor becomes your best friend! We are here to educate you on proper structure alignment to allow your nervous system to function at its optimal state. Without proper alignment, your body will compensate and it can easily do that for years, but at some point you will know that it is time to have a maintenance check up before you start losing parts (organs and tissue cells) under the surgeon’s knife (expensive invasive procedures) and start numbing the area with all kind of drugs. (Pharmakeia or Pharmaceutical)

Maintenance care allows those muscles and ligaments to reshape during proper spinal alignment following a specific Chiropractic adjustment. It requires time and repetition, but it is reachable. Just think how long do you need to have braces when you want your teeth to straighten out? On average 2-3 years, well did you know that only one ligament surround your tooth? Did you know that 12 ligaments surround the first bone in your neck, called the Atlas vertebra? Like we said, it takes time and repetition to reshape those muscles and ligaments. It is attainable through specific Chiropractic adjustments and specific Chiropractic exercises.

Often time people think that Chiropractic adjustments are a “pop” or a “crack”. They may even think that it is risky for the body, but in scientific terms, it is called cavitations. In other terms, your bones are not making the noise. Gases contained within the joint fluid produce it. Chiropractors adjust the bone into its proper alignment with a low amplitude and fast speed motion of the joint, which create an empty space in your joint cavity. The fluid in that cavity is filled with gases that fill up the empty space and produce noise. Remember that in space there is no air = no noise.

Cavitation: Formation of gas bubbles in the synovial fluid caused by a decrease in pressure. This process is responsible for the “cracking” of knuckles and other joints. Mosby’s Dictionary of Complementary and Alternative Medicine. (c) 2005, Elsevier.)

Scientific Articles:

Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence

Cifuentes, Manuel MD, PhD; Willetts, Joanna MS; Wasiak, Radoslaw PhD, MA, MSc


Objectives: To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

Method: A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

Results: Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

Conclusions: In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.

Does maintained Spinal manipulation (adjustment) therapy for chronic non-specific low back pain result in better long term outcome?

Senna MK, Machaly SA. Rheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University. Spine (Phila Pa 1976). 2011 Jan 17. [Epub ahead of print]

Study Design:  A prospective single blinded placebo controlled study was conducted.

Objective:  To assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic non-specific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments.

Summary of background:  SMT is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic non-specific LBP has not been studied.

Subjects and Methods:  60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized to receive either (1) 12 treatments of sham SMT over a one-month period, (2) 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months, or (3) 12 treatments over a one-month period, along with “maintenance spinal manipulation” every two weeks for the following nine months. To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-month, 4-month, 7-month and 10-month intervals.

Results:  Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029 respectively). However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the no maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level.

Conclusion:  SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.

The Nordic Maintenance Care Program: case management of chiropractic patients with low back pain – defining the patients suitable for various management strategies. 

Malmqvist,S.;Leboeuf-Yde,C. CHIROPRACTIC & OSTEOPATHY. JUL Vol. 17(7) pp. 7-7

BACKGROUND: Maintenance care is a well known concept among chiropractors, although there is little knowledge about its exact definition, its indications and usefulness. As an initial step in a research program on this phenomenon, it was necessary to identify chiropractors’ rationale for their use of maintenance care. Previous studies have identified chiropractors’ choices of case management strategies in response to different case scenarios. However, the rationale for these management strategies is not known. In other words, when presented with both the case, and different management strategies, there was consensus on how to match these, but if only the management strategies were provided, would chiropractors be able to define the cases to fit these strategies? The objective with this study was to investigate if there is a common pattern in Finnish chiropractors’ case management of patients with low back pain (LBP), with special emphasis on long-term treatment.

METHOD: Information was obtained in a structured workshop. Fifteen chiropractors, members of the Finnish Chiropractors’ Union, and present at the general assembly, participated throughout the entire workshop session. These were divided into five teams each consisting of 3 people. A basic case of a patient with low back pain was presented together with six different management strategies undertaken after one month of treatment. Each team was then asked to describe one (or several) suitable case(s) for each of the six strategies, based on the aspects of 1) symptoms/findings, 2) the low back pain history in the past year, and 3) other observations. After each session the people in the groups were changed. Responses were collected as key words on flip-over boards. These responses were grouped and counted.

RESULTS: There appeared to be consensus among the participants in relation to the rationale for at least four of the management strategies and partial consensus on the rationale for the remaining two. In relation to maintenance care, the patient’s past history was important but also the doctor-patient relationship.

CONCLUSIONS: These results confirm that there is a pattern among Nordic chiropractors in how they manage patients with LBP. More information is needed to define the “cut-point” for the indication of prolonged care.

Efficacy of Preventive Spinal Manipulation for Chronic Low-Back Pain and Related Disabilities: A Preliminary Study.

Descarreaux M, Blouin J-S, Drolet M, Papadimitriou S, Teasdale N. J MANIPULATIVE PHYSIOL THER. 2004 OCT; 27(8) pp. 509-15

Objective: To document the potential role of maintenance chiropractic spinal manipulation to reduce overall pain and disability levels associated with chronic low-back conditions after an initial phase of intensive chiropractic treatments.

Methods:  Thirty patients with chronic nonspecific low-back pain were separated into 2 groups. The first group received 12 treatments in an intensive 1-month period but received no treatment in a subsequent 9-month period. For this group, a 4-week period preceding the initial phase of treatment was used as a control period to examine the sole effect of time on pain and disability levels. The second group received 12 treatments in an intensive 1-month period and also received maintenance spinal manipulation every 3 weeks for a 9-month follow-up period. Pain and disability levels were evaluated with a visual analog scale and a modified Oswestry questionnaire, respectively.

Results:  The 1-month control period did not modify the pain and disability levels. For both groups, the pain and disability levels decreased after the intensive phase of treatments. Both groups maintained their pain scores at levels similar to the postintensive treatments throughout the follow-up period. For the disability scores, however, only the group that was given spinal manipulations during the follow-up period maintained their postintensive treatment scores. The disability scores of the other group went back to their pretreatment levels.

Conclusions:  Intensive spinal manipulation is effective for the treatment of chronic low back pain. This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective postintensive treatment disability levels. Future studies, however, are needed to confirm the finding in a larger group of patients with chronic low-back pain.

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