Stages of care
For most people in Chiropractic care, there are three possible stages to the process:
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This could also be called the “acute” or “intensive” stage of care. During this stage, we are mindful of getting the worst of your symptoms under control and settling down inflammation. Everyone will respond differently at this point, but you may find that any symptoms you’re experiencing fluctuate significantly, and you may notice the location of pain moving around. Your schedule of care will need to be more frequent during this stage, in order to build momentum and not let things slip back to square one. How long this stage lasts will vary, but two-to-three weeks is likely.
During this stage, you are more likely to need to use ice to help manage your symptoms at home. You may find that things get a little worse before they get better for the first couple of visits. Generally speaking, we won’t prescribe many exercises or stretches during this stage, as we want to see how your body responds to the adjustments we’re carrying out during visits. Any homework given at this stage is more likely to consist of discussion of ergonomics, and avoidance of activities that may be provoking your symptoms.
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We could equally name this the “corrective”, “recovery”, “strengthening” or “rebuilding” stage of care. Having reduced symptoms substantially, this is when we can really make a difference for the long-term. We can treat your condition proactively rather than reactively, as we are not having to deal so much with immediate issues; instead, we can create a good foundation for the long-term health of your spine.
We are likely to continue with spinal adjustments as the core approach in this corrective phase, but we can also start to introduce exercises and stretches, which you will now be in a better position to perform effectively.
Some people may choose to begin their care at this stage, if they are not experiencing particular symptoms at that time but have ongoing issues they wish to get to the bottom of.
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Once we’re happy that everything is in good condition, you may wish to continue with the next phase of care: maintenance. Here, we continue to adjust your spine every once in a while, to keep it in the best possible condition.
Is this necessary? Well, in a perfect, stress-free world, it probably wouldn’t be necessary. In reality, however, most of us encounter stresses (physical, emotional, and chemical) in day-to-day life that can cause regression.
We can think of maintenance care in two ways: “prevention”, and “wellness”.
Prevention - some may choose to stay adjusted in order to prevent future issues from occurring, nipping them in the bud before they become more difficult to treat. This is similar to why we brush our teeth regularly (even if we don’t currently have problems with our teeth).
Wellness - others may choose to stay adjusted because they enjoy the health benefits this gives them, and feel that it enables them to get the best out of life. This is more akin to why some people enjoy exercising or going to the gym (ie. not just to lose weight or avoid becoming ‘unfit’ - rather, because they enjoy being as fit and healthy as possible).
Not everyone chooses to continue with Chiropractic in this way, and it’s totally up to you whether you do. Most people will find, however, that the greatest benefits - and the greatest value - comes after the initial relief stages. This is because pain is usually the tip of the iceberg - our bodies can put up with a lot before things get bad enough to trigger pain. When relief from pain has been achieved, this is when the real progress can be made.
Is it worth it?
You might well wonder whether the second and third stages of Chiropractic care (ie. beyond the immediate resolution of symptoms) are really worth bothering with.
A number of studies have been carried out over the past decade that strongly make the case for this approach. Building on a previous Randomised Controlled Trial from 2011 (1) that showed that spinal manipulation therapy is effective for the treatment of chronic lower back pain and that maintenance provides a long-term benefit, two further studies have been conducted (in 2018, 2020; (2), (3)).
RCT findings - the studies found that those patients who received maintenance treatment of spinal manipulation experienced substantially fewer days of pain per year, and that pain was less severe and more stable. They also found that this group of patients actually only ended up needing an average of less than two extra visits per year than the group that used Chiropractic in a more ‘reactive’ way (only getting treatment when they felt they needed it in an emergency).
It’s great to see the evidence supporting what Chiropractors have noticed for years - that maintenance care is not only effective but also represents the best possible value - in fact, it may even end up costing you less in the long-term.
This can all be summed up with this image, showing the difference between maintaining spinal health steadily, as opposed to allowing things to regress and needing to start the process all over again. With the reactive approach, you may well actually end up needing more care in the long-run, rather than less.
It also shows the initial stage of care (relief stage), during which things may initially get a little worse before they get better.
What’s right for you?
All that said, this approach won’t be right for everyone - it’s up to you to decide what’s right for you. I can offer some thoughts about what’s right for most people though - and even tell you what I do.
For myself, I wouldn’t leave it longer than a month between adjustments. I do have a job that puts significant stress on my spine though (ironically)! Most people will find something between 3 weeks and 6 weeks to be optimal, but in some cases you may even still get the desired benefit from as long as 2-3 months. I would be cautious about leaving it any longer than that though, and certainly you should look to keep the follow-up to within 6 months, as that’s more than long enough for new patterns of imbalance to develop that might set you back a stage.
