New research demostrates the effectiveness of chiropractic maintenance care for persistent and recurrent low back pain.
A pragmatic randomized controlled trial in 2018 wanted to see if regular maintenance care that chiropractors recommend really was useful.
Here at the Avenue Clinic we try to be as evidence based as we can and so this caught my eye. Maybe it is not as effective as we tell you after all and we should be advising you to do something else. Research shows that exercise is the best thing to reduce recurrences, breathing is thought to be effective for reducing back pain, core stability helps reduce the recurrence of low back pain but what does research say now about maintenance care and how it helps these other good things to reduce your low back pain?
The people they used for the trial were those with recurrent or persistent low back pain that had been described as ‘non specific’. This means that after having undergone an examination or ‘triaged’ to identify whether you had serious pathology, which would require further examination, there was found to be no pathological or anatomical reason for the pain.
You know I keep on about the power of exercise and I’m sure you are fed up with it if you don’t enjoy exercising! However, exercise and exercise in combination with education from a chiropractor has consistently been shown to be effective in preventing new episodes of low back pain or at least reducing the impact of the problem. As we want the best for you, the patient, this is what we will continue to recommend.
We often advise you to come back every so often for a check up if you are a back pain sufferer and we do so because we believe that the treatment helps does us reminding you what to do and not to do help and then we can reinforcing the need to exercise which helps.
This trial was car out to investigate just how effective these maintenance treatments are for you, the patient.
Do they help reduce recurrences; do they help to reduce the severity of the recurrence? Do they ultimately save you money and pain – that is the most important thing for you, the patient to consider.
At the Avenue Clinic, we pride ourselves on only treating you as often as you need it .. but that is often difficult to predict, particularly if you have had recurrent back pain for many years. We want to make sure you are getting the best treatment possible so this study was of great interest to us. Should you come in to see us before you are in a lot of pain or should you wait until the pain is unbearable? Does the research say anything to help us or you to decide.
How was the study carried out?
Two groups of people aged between the ages of 18 and 65 years were created who had non specific low back pain who had responded well to chiropractic care in the past. ‘Responded well’ means that patients had shown significant improvement in their pain by the 4th treatment, not that they were painfree, just feeling better. Only those who reported being ‘definitely improved’ were eligible for inclusion.
The patients had also reported more than 30 days of low back pain over a 12 month period and they had recurrent low back pain episodes.
They were treated and put into either a control group or a Maintenance Care (MC) group.
The number of treatments and frequency of visits was tailored to each patient’s needs but patients were told to come in for maintenance care before substantial pain occurred and with no longer than 3 months between treatments. Those in the control group only came in for treatment when the pain recurred and they could report as ‘bothersome’ which meant the pain was affecting their daily activities. at which point they came in for as many treatments as was necessary to give maximum benefit.
328 subjects were allocated randomly to one of the two treatment groups and during the 12 months of the study period those who undertook regular maintenance care reported
13 days fewer of bothersome low back pain compared to the control group.
The treatment they received was 1.7 more treatments than the control group.
Whilst exercise (sorry!!) along with treatment is always and should be used as the best first line of treatment for those with chronic,
recurrent low back pain, there are of course some of you who for whatever reason cannot exercise or just refuse or mean to do it but don’t make the time – whatever reason, you just don’t keep it up, and therefore the good news from this study is that as long as you are someone who DID respond well by the 4th treatment initially, then
maintenance care is a good alternative form of help for you that will help to reduce your pain bouts and keep them shorter.
It is up to us as chiropractors to keep monitoring your response to treatment always, and we do, but this should encourage you if you really can’t do or keep up with exercise programmes. We are happy therefore, at the Avenue Clinic, to continue to recommend maintenance care where appropriate in order to reduce the number of episodes of low back pain and the intensity of that pain.
This research was undertaken by Andreas Eklund et al PLoS ONE 13(9): e0203029.