Chiropractic for prevention: the latest research on maintenance care

What the latest research says about chiropractic for prevention and the resulting patient health benefits

In the chiropractic community, many evidence-based practitioners just didn’t see the benefits in chiropractic for prevention and maintenance care — until recently, that is, says Jeff Williams, DC, FIANM, of Creek Stone Integrated Care in Amarillo, Texas.

“[Recent studies] make it clear that chiropractors shouldn’t simply make blanket maintenance recommendations to every patient they have. But when made for the right patients, maintenance can now be considered an evidence-based recommendation,” says Williams, a diplomate of the International Academy of Neuromusculoskeletal Medicine and host of The Chiropractic Forward Podcast.

Williams cites three recent studies — the first is “The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain — A pragmatic randomized controlled trial.”

“[This] paper by Andres Eklund was important because it showed fairly definitively that maintenance care can be considered evidence-based when prescribed for patients suffering recurrent or persistent low-back pain. Before this paper came out, many in the evidence-based chiropractic community scoffed at the idea of recommending maintenance care,” explains Williams. “However, Eklund’s paper showed those undergoing symptom-related care versus maintenance care experienced about 13 more days in pain per year when compared to the maintenance care patients. In addition, the maintenance care patients only saw the chiropractor about two more visits over the course of the year.”

He adds, “If someone were to offer me two extra days of treatment, but almost two weeks less in pain for the year, I’d ask where the paper is to sign myself up.”

The second paper Williams cites is also by Eklund, but even more recent: “The Nordic Maintenance Care Program: Does psychological profile modify the treatment effect of a preventive manual therapy intervention? A secondary analysis of a pragmatic randomized controlled trial.”

“Eklund’s second study showed us that it may be important whom we recommend maintenance to. It’s not as effective for every patient,” explains Williams. “For example, those in what was termed ‘the dysfunctional subgroup’ receiving maintenance care had fewer days with pain while the group they termed ‘the adaptive coper subgroup’ actually had more days with pain with more treatments.”

The final study that Williams refers to is “Chiropractic maintenance care – what’s new? A systematic review of the literature” on chiropractic for prevention.

“Systematic reviews are at the top of the research pyramid, so it gives us high-level information on maintenance chiropractic care,” Williams says. “Also important is that it is current — 2019 — thus relevant. This paper is important, in my view, because it is the first paper on maintenance care to my knowledge to come to the conclusion that ‘maintenance care can be considered an evidence-based method to perform secondary or tertiary prevention in patients with previous episodes of low-back pain, who report a good outcome from the initial treatments.”

As the body of chiropractic research grows, evidence-based practitioners are now faced with chiropractic as prevention for certain patients for maintaining optimal body function for patients throughout their lifetime.