By Dr. Andrew Johnston, DC
Did you know that up to 70% of people worldwide will experience low back pain at some point in their life? Low back pain is one of the leading causes of disability and lost work time, and research shows that 5% to 10% will continue on to chronic low back pain, which is defined as pain that continues for three months or longer. There is a marked increase in prevalence of chronic low back pain from the ages of 30-60 years old (occupational years). Doctors of chiropractic have utilized maintenance or wellness care as a preventative measure for chronic low back pain for decades. Newly published research shows that maintenance care or pre-planned manual therapy is an effective management plan. They define maintenance care as an individually tailored, clinician-controlled, preventative care treatment plan for patients with persistent and recurrent chronic low back pain.
A recent trial found that patients who received maintenance chiropractic care experienced less days of bothersome low back pain than those who did not. Eklund et al. in 2018 found that maintenance care patients (n=161) compared to the symptom-guided treatment patients (n=158), had 12.8 FEWER DAYS of bothersome LBP for a 52-week period. The maintenance care group received, on average, 1.7 more visits during the 12 months. In a secondary analysis by Eklund et al. in 2019 and 2020, they reported that a subgroup labelled as “dysfunctional” (high pain, high distress, low activity levels, and marked interference with activities of daily living) who received maintenance care had 30 FEWER DAYS of bothersome low back pain. This also showed an increase in PAIN FREE weeks and a reduction in the number of days in pain during an acute episode.
We use this new emerging evidence in combination with our clinical expertise and patient values to provide the optimal management plan for each individual case. At Washington Park Chiropractic, we provide graded exercise rehabilitation in conjunction with maintenance care to strengthen the spine and meet the specific goals of our patients. We also provide advice and education to address psychosocial factors that may be contributing to chronic low back pain. The research shows that this multimodal approach to care results in the best patient outcomes.
Every patient with chronic low back pain is different, and there are a multitude of factors that are considered prior to planning the frequency of an individual’s maintenance care. Patient information that we take into account includes thorough medical history, frequency of pain, intensity of pain, duration of pain, average time between flare ups or exacerbation, patient expectations, positive prior outcomes to manual therapy, and social determinants of health to name a few. If you are someone who suffers from recurrent low back pain, then maintenance care is an option for you.
Ferguson, S.A., Merryweather, A., Thiese, M.S. et al. Prevalence of low back pain, seeking medical care, and lost time due to low back pain among manual material handling workers in the United States. BMC Musculoskelet Disord 20, 243 (2019). https://doi.org/10.1186/s12891-019-2594-0
Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015;49:1. doi:10.1590/S0034-8910.2015049005874
Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015;49:1. doi:10.1590/S0034-8910.2015049005874
Leboeuf-Yde C, Hestbaek L. Maintenance care in chiropractic--what do we know?. Chiropr Osteopat. 2008;16:3. Published 2008 May 8. doi:10.1186/1746-1340-16-3
Eklund A, Jensen I, Leboeuf-Yde C, et al. 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. PLoS One. 2019;14(10):e0223349. Published 2019 Oct 10. doi:10.1371/journal.pone.0223349
Eklund, A., Hagberg, J., Jensen, I. et al. The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain - a secondary analysis of a pragmatic randomized controlled trial. Chiropr Man Therap 28, 19 (2020). https://doi.org/10.1186/s12998-020-
00309-6
Eklund A, Jensen I, Lohela-Karlsson M, et al. 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. PLoS One. 2018;13(9):e0203029. Published 2018 Sep 12. doi:10.1371/journal.pone.0203029
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