Do You Only Need a Chiropractor When You Are in Pain?

You came in with back pain. After a few weeks of treatment, you are feeling much better. So the question comes up: should you keep coming, or are you done?

It is a fair question. For some people, ongoing preventive care makes a meaningful difference. For others, it does not. The research has become much clearer about who falls into each group.

Back pain tends to come back

Low back pain is one of the most recurrent conditions in healthcare. Many people who experience a significant episode of low back pain will have another episode within the following year.

This is where maintenance care comes in. Rather than waiting for pain to return and starting from scratch each time, the idea is to schedule visits at longer intervals to maintain the improvements you have already made.

For years, this was based more on clinical experience than hard data. That changed with a landmark trial out of Scandinavia.

The largest trial to date

In 2018, a team of researchers published what remains the most rigorous study on this question. It was a randomised controlled trial, the gold standard in clinical research, involving 321 patients with recurrent or persistent low back pain. Every patient had already responded well to an initial course of chiropractic care. They were then randomly assigned to one of two groups:

Maintenance care: Pre-scheduled visits at regular intervals, regardless of symptoms.
Symptom-guided care: Patients only returned when a new episode occurred.

The trial ran for a full year. The maintenance care group reported roughly 13 fewer days in bothersome pain over that period, approximately 85 days compared to 98 days in the symptom-guided group. The trade-off was modest: about two additional visits across the entire year (Eklund et al., 2018).

Nearly two fewer weeks of missed training, disrupted sleep or sitting at your desk unable to concentrate. Two extra visits to achieve it. That is a trade-off worth considering.

Who benefits most

A follow-up subgroup analysis went further. Researchers looked at which patients gained the most from maintenance care and found that those whose pain was having the greatest impact on their daily lives saw the largest benefit: approximately one month fewer days in pain and more pain-free weeks over the year (Eklund et al., 2020).

The takeaway is that maintenance care is not a blanket recommendation. It appears most beneficial for people who experience frequent or disruptive flare-ups. For those who manage well on their own between episodes, coming in only when needed is a perfectly good approach.

What happens without follow-up

A separate trial published in Spine looked at what happens to treatment gains over time. Patients with chronic low back pain received either spinal manipulation for one month, sham treatment or spinal manipulation followed by twice-monthly maintenance visits for 10 months.

Patients who received the initial treatment but no follow-up saw their improvements gradually decline. By the end of the study, their pain and disability scores had returned toward pre-treatment levels. The maintenance group largely retained their improvements over the study period (Senna and Machaly, 2011).

This does not mean everyone needs ongoing care. But for chronic or frequently recurring problems, a short course of treatment alone may not produce lasting change.

Who is it appropriate for?

Based on the evidence, maintenance care suits a specific profile:

Recurrent episodes. Multiple bouts of back or neck pain over the past year or longer.
Good initial response. You responded well to your initial course of treatment.
Significant impact. When pain flares, it meaningfully affects your ability to work, exercise or sleep.
Difficulty self-managing. Flare-ups tend to escalate before you seek help, rather than settling on their own.

Researchers from the Nordic trial developed a screening tool (the MAINTAIN instrument) that showed good accuracy in identifying suitable patients by evaluating pain severity, daily interference, emotional distress, sense of control and social support (Eklund et al., 2022).

What it looks like in practice

Maintenance care is not the same as your initial treatment plan:

Longer intervals. Typically once every four to eight weeks.
Shorter sessions. The focus is on maintaining function, not managing a crisis.
Active participation. Exercise, movement habits and self-management are central to the plan.
Ongoing reassessment. If you are doing well, we space visits further apart. If something is flaring, we address it early.

When it is probably not necessary

Maintenance care is probably not for you if:

You had a single episode of back pain that resolved and has not returned
You manage occasional stiffness well on your own with exercise and movement
You bounce back quickly from minor flare-ups
You have no history of recurrent spinal pain

In these cases, coming in only when you need to is a perfectly reasonable approach.

Understanding the recommendation

Research consistently shows that patients often have a limited understanding of why ongoing care is recommended (Hjertstrand et al., 2021). If a chiropractor suggests maintenance visits, you should expect a clear explanation of why it is appropriate for your situation, what the expected benefit is, how often and what you can do on your own between visits.

If you are unsure whether maintenance care makes sense for you, get in touch or book an appointment. We are happy to talk it through.

References

DO YOU ONLY NEED A CHIROPRACTOR WHEN YOU ARE IN PAIN?