When a period of therapy comes to an end and a patient is discharged, it is common to wonder what should be done next and how to behave in order to avoid relapses. This is especially true after a long and demanding recovery, such as following a diagnosis of acute disc herniation or in cases of chronic low back pain — conditions that may require anywhere from two to six months, or even up to a year, of treatment.
Until now, the answer has largely been left to the discretion of the practitioner. Two studies conducted in 1996 and 2008 on chiropractic patients showed no clear evidence regarding the follow-up practices used over the past twenty years. This does not mean that those programs were ineffective — rather, they had not been evaluated through randomized double-blind trials. Some patients were monitored monthly, others every three months, and still others every six months.
Toward the optimization of body mobility
Chiropractic care has always promoted an approach aimed at optimizing body mobility, ensuring an optimal response to the stresses of daily life. In its approach to the patient, chiropractic emphasizes
Clinicians know that those who receive regular treatments generally feel better overall, but until recently, no evidence had yet demonstrated this scientifically.
In 2018, the Nordic Maintenance Care Program — a study conducted in Northern Europe — examined the effectiveness of chiropractic maintenance care (MC) for recurrent or persistent non-specific low back pain.
The results showed that maintenance chiropractic care reduced the number of weekly pain days and increased the duration of pain-free periods compared to symptomatic treatment, among patients who had already responded positively to an initial course of manual therapy.
In this randomized double-blind study conducted by Scandinavian chiropractors, patients with recurrent non-specific low back pain who had responded well to an initial treatment cycle were divided into two groups.
Patients in the first group were instructed to return only if symptoms reappeared, while those in the second group received regular treatments at the chiropractor’s discretion over the following two years.
The treatment frequency ranged from once a month to once every six months, with an average interval of about nine weeks — roughly every two and a half months.
Chiropractic care combined with specific exercises
Another study, published in 2020, reviewed 3,238 scientific articles and selected 14 that met the inclusion criteria related to maintenance care. The paper not only analyzed data concerning the frequency of pain episodes but also sought to determine whether there is a consensus on what maintenance care actually entails — specifically, what type of treatment should be provided and whether chiropractors define maintenance care in a consistent way.
In conclusion, patients who participated in long-term maintenance care programs across multiple studies experienced, on average, 13 fewer days of low back pain per year compared to those who sought treatment only when symptoms appeared.
The studies analyzed also showed that the best outcomes were achieved by groups who combined chiropractic care with specific exercise programs aimed at maintaining mobility and strength. Over the past ten years, scientific research has finally allowed us to propose evidence-based programs for long-term prevention in patients who have already experienced acute or recurrent episodes of low back pain. In the Scandinavian study, this group represented approximately 30% of the total patient population.
Primary prevention — that is, staying healthy to avoid the onset of problems — still remains an area to be further explored. It is an ambitious goal, but time will tell what developments the next decade will bring. At present, this approach is mainly applied among professional athletes, where planning and monitoring are carried out with daily precision.
It should nevertheless be remembered that, despite all possible prevention and care, one can never be completely immune to occasional episodes. The variables involved are numerous, and reducing health to a mere series of tests and treatments will always be a simplistic approach when compared to the complexity of human activity.
