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Posted on 06-17-2014

Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain

As a Baltimore Chiropractor who spends a lot of time treating acute injuries such as those commonly experienced in auto accidents, slips and falls, and work-related injuries, one thing I do not spend a lot of time addressing is the benefits of chiropractic care in cases of chronic pain. That is, typically I talk about new injuries and the importance of restoring normal spinal motion to help patients get relief from acute pain. Unfortunately not every patient that I treat related to these acute injuries is able to return to pre-injury status and to become pain free. Rather, a small percentage of these patients become chronic pain patients that I will either refer to other specialists (neurologist, orthopedist, pain management specialist, etc) or that choose to live with their chronic pain.

When it comes to chiropractic care there is often a concern from prospective new patients that once they begin a course of treatment that they will have to continue care indefinitely. I can assure you that that is not the case. Like any good book there is a beginning, a middle and an end. I make sure to let patients know that care will not be forever. Typically they will have an initial evaluation, a course of treatment over the next several weeks, a re-evaluation to assess their improvement (if any), a new course of treatment, and soon thereafter a final evaluation.

A recent article set out to address whether or not maintained spinal manipulation (that is, continued lower back spinal manipulation after the acute phase of care has ended) would lead to better clinical outcomes such as reduced recurrences of lower back pain and decreased pain levels. The article can be found here: http://www.ncbi.nlm.nih.gov/pubmed/21245790. For those who may be reading this article in print you can click the link to the article on my blog at www.midatlanticspinalrehab.com.

In the study a total of 60 patients were enrolled. Each had a history of nonspecific chronic lower back pain lasting at least six months or longer. During the study the participants were divided into three treatment groups.

Group 1: Participants were subjected to 12 "sham" manipulations within one month
Group 2: Participants were subjected to 12 "true" chiropractic manipulations within one month
Group 3: Participants were subjected to 12 "true" chiropractic manipulations within one month plus "maintenance" manipulations once every two weeks for the next 9 months. 

Each of the categories of patients were followed up with at one, four, seven, and ten month intervals to assess their subjective pain levels and to perform self reporting guidelines regarding their degrees of disability, if any.

The results of the study concluded that patients in the third group that received "true" chiropractic manipulations as well as "maintenance" manipulations biweekly for several months showed the most improvement in their pain levels and disability.

The conclusions from this study are important. Firstly, they demonstrate that spinal manipulation is an effective tool for managing chronic lower back pain. Additionally, it demonstrates the importance of continued chiropractic spinal manipulation even after the first month of therapy to help "maintain" progress.

While I can empathize with patients who might be concerned about needing to follow up with treatments forever, it is important to know that research supports the need for periodic "tune-ups." Even patients that I have treated for acute neck and lower back pain would benefit from periodic adjustments to help maintain the improvements that they received while under my care. It is not uncommon to have patients that were once under my care for acute auto accident or work-related injury care to return to my office for periodic adjustments just to maintain their levels of improvement.

If you or someone you know are suffering from chronic lower back pain and need some help to get out of pain please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We are conveniently located at 2001 Eastern Avenue in Fells Point, Baltimore. We would be glad to help!

Dr. Gulitz

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