Low back pain (LBP) is a common and burdensome health issue affecting millions worldwide. Its recurrence and persistence pose significant challenges, often leading individuals down a frustrating path of pain and reduced mobility. A lot of chiropractic treatment helps to decrease pain intensity but a proactive approach decreases the likelihood of pain flare-ups. This is known as ‘maintenance care’.
Chronic LBP has a ripple effect on individuals, affecting their families, work, lifestyle and society. It is the leading cause of work absence and activity limitation globally. Its recurrent nature increases this burden, highlighting the critical need for preventive strategies. Alongside hands-on chiropractic treatment, exercise and education play pivotal roles, offering hope for individuals grappling with recurrent LBP.
Chiropractors, skilled in musculoskeletal assessment and treatment, play a pivotal role in managing LBP. Manual therapies, including spinal manipulation and mobilization, are commonly employed to alleviate pain and improve function. Additionally, chiropractors often recommend maintenance care — a preventive approach aimed at reducing the risk of relapse and optimizing long-term well-being.
A 2018 randomised controlled trial by Eklund et al. investigated the effectiveness of maintenance compared to symptom-guided care in individuals with recurrent or persistent LBP. The study replicated real-world clinical practices, offering valuable insights into the efficacy of maintenance care. The trial compared maintenance care against its control group of symptom-guided care. The maintenance care group aimed to schedule chiropractic appointments before substantial pain, meaning appointments were pre-booked and controlled by the clinician. In the control group, the patients were instructed to book when pain occurred, meaning the appointments were not pre-booked and were controlled by the patient.
The trial revealed that maintenance care was more effective than symptom-guided care in reducing the total number of days with bothersome LBP over 52 weeks. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, maintenance care should be considered an option for long-term prevention.
In the struggle against recurrent LBP, exercise, education, and maintenance care emerge formidable allies. By embracing proactive strategies and evidence-based interventions, individuals can reclaim control over their well-being and navigate the journey of recovery with resilience and optimism. As chiropractors continue to champion holistic approaches to musculoskeletal health, the promise of maintenance care shines brightly, offering hope and healing to those in need.
References:
Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, Bodin L, Axén I. 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. 2018 Sep 12;13(9):e0203029.
Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74. 10.1136/annrheumdis-2013-204428
da Silva TM, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ. Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. 2017:1–27.
Steffens D, Maher CG, Pereira LS, Stevens ML, Oliveira VC, Chapple M, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016;176(2):199–208. 10.1001/jamainternmed.2015.7431
ringsli M, Berntzen A, Olsen DB, Leboeuf-Yde C, Hestbaek L. The Nordic Maintenance Care Program: Maintenance care—what happens during the consultation? Observations and patient questionnaires. Chiropr Man Therap. 2012;20(1):25 10.1186/2045-709X-20-25
