Chiropractic Maintenance Care – What’s New?

A Systematic Review of the Literature

Chiropractic & Manual Therapies 2019; Vol. 27:63

Axén Iben, Hestbaek Lise, Leboeuf-Yde Charlotte

In the realm of chiropractic care, the concept of Maintenance Care has emerged as a key strategy for managing recurrent spinal pain and preventing future episodes. A recent systematic review delved into the literature to illuminate the efficacy and application of Maintenance Care, shedding light on its prevalence, patient outcomes, and the perspectives of both chiropractors and patients.

  • Defining Maintenance Care: Maintenance Care represents a traditional chiropractic approach wherein patients continue treatment beyond the point of symptom relief to sustain optimal health and function. It is primarily recommended for individuals with a history of previous pain episodes who have responded positively to chiropractic interventions.
  • Prevalence and Belief in Efficacy: Approximately 30% of Scandinavian chiropractic patients receive Maintenance Care, reflecting a widespread belief in its efficacy among both chiropractors and patients.
  • Positive Patient Outcomes: Patients undergoing Maintenance Care reported fewer days with low back pain compared to those receiving treatment on an as-needed basis, highlighting its potential for reducing symptom burden and improving quality of life.
  • Consensus Among Chiropractors: There exists reasonable consensus among chiropractors regarding the definition and application of Maintenance Care, emphasizing its role as a preventive approach aimed at averting future pain episodes.
  • Shift in Treatment Paradigm: Unlike the historical perception of spinal pain as a self-limiting ailment, it is now recognized as a recurring disorder necessitating long-term management strategies akin to chronic conditions like asthma.
  • Components of Maintenance Care: Maintenance Care encompasses a range of treatment modalities, including manual therapy, exercise prescriptions, ergonomic advice, and stress management techniques, aimed at empowering patients to adopt healthy lifestyle habits.
  • Predictors for Recommending Maintenance Care: Chiropractors are more likely to recommend Maintenance Care for patients with a history of previous episodes who have responded well to treatment, as well as those experiencing significant stress or physical strain.
  • Evidence for Effectiveness: Studies consistently demonstrate favorable outcomes for patients undergoing Maintenance Care, with significant reductions in bothersome pain and improved overall well-being compared to alternative treatment approaches.
  • Variability in Application: While Maintenance Care is widely embraced within the chiropractic community, its precise application varies among practitioners, ranging from selective use based on patient response to a universal recommendation for all patients.
  • Role of Chiropractors as Back Pain Coaches: Chiropractors are uniquely positioned to serve as coaches in the management of chronic back pain, leveraging their expertise and long-term relationships with patients to optimize treatment outcomes.
  • Chronic Disease Management Paradigm: Given the chronic nature of back pain, a preventive approach like Maintenance Care holds promise for minimizing symptom exacerbations and enhancing overall patient well-being.
  • Interplay of Treatment Components: The effectiveness of Maintenance Care may stem not only from the specific treatments administered but also from the therapeutic alliance between chiropractors and patients, underscoring the importance of the clinical encounter.

In conclusion, Maintenance Care emerges as a valuable tool in the chiropractic armamentarium, offering a preventive approach to managing recurrent spinal pain and improving long-term outcomes for patients. While further research is needed to elucidate its mechanisms of action and optimize its implementation, Maintenance Care holds significant promise as a cornerstone of holistic chiropractic practice.