Chiropractic Treatment Program Guidelines

For many musculoskeletal conditions that cause back or neck pain, 2 to 3 visits to the chiropractor per week for a few weeks should start bringing noticeable symptom relief. Multiple studies have shown that about 12 total treatment sessions with a chiropractor over a 6-week period is commonly enough to complete a treatment program for back pain relief, ¹ Haas M, Vavrek D, Peterson D, Polissar N, Neradilek MB. Does-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. Spine J. 14(7):1106-1116. doi:10.1016/J.SPINEE.2013.07.468 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989479/ especially when combined with other treatments. ² Goertz CM, Long CR, Vining RD, et al. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial. JAMA Netw Open. 2018;1(1):e180105. doi:10.1001/jamanetworkopen.2018.0105

Common Chiropractic Treatment Plans

A chiropractor specifically designs a treatment plan for the patient using spinal manipulation and/or spinal mobilization as well as extremity joint manual therapies as necessary to reduce pain, restore motion, and prevent recurrence. Many chiropractors utilize other forms of treatment along with manipulative therapy including exercise training and soft-tissue therapies (trigger point, Graston, manual release techniques, and more), and physical therapy modalities (electrical stimulation, ultrasound, laser, pulsed magnetic field, and more). In general, in the absence of progressive worsening of a condition during chiropractic care, a common chiropractic program is 3 times per week for 2 to 4 weeks, followed by a re-evaluation.

If improvement is noted, a tapering of treatment frequency is appropriate while introducing self-help and home-based recommendations (examples below). Over time, the frequency of spinal manipulations and/or spinal mobilizations are usually reduced to an as-needed follow-up plan.

Chiropractors often give advice on how to avoid future problems by evaluating

• Home exercise program. Patient-specific exercises and stretches are often started early in care, usually within the first 3 visits as multiple studies support spinal manipulation with exercise produces the best outcomes or results. ³ Evans R, Haas M, Schulz C, Leininger B, Hanson L, Bronfort G. Spinal manipulation and exercise for low back pain in adolescents: a randomized trial. Pain. 2018;159(7):1297–1307. doi:10.1097/j.pain.0000000000001211 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205160/ ^{, 4} Schulz C, Evans R, Maiers M, Schulz K, Leininger B, Bronfort G. Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial. Chiropr Man Therap. 2019;27:21. Published 2019 May 15. doi:10.1186/s12998-019-0243-1 ^{, 5} Leininger B, McDonough C, Evans R, Tosteson T, Tosteson AN, Bronfort G. Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain. Spine J. 2016;16(11):1292–1304. doi:10.1016/j.spinee.2016.06.014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106317/

  See Easy Exercise Program for Low Back Pain Relief

• Ergonomics. Altering detrimental or asymmetric lifestyle habits or implementing various back supports, belts, or pillows to better support the spine may be recommended. Instruction may also be given for ergonomically correct ways to bend, lift, pull, and push.
• Posture. May include analysis of gait, sitting posture, or standing posture. Performing stretches and massages with a foam roller, and exercises with elastic bands may be recommended for home use to help improve posture.

  See Good Posture Helps Reduce Back Pain

• Orthotics. The use of specialized shoe insoles and/or a heel lift may help reduce postural imbalance.
• Diet. Tips for eating a healthier diet may reduce pain from chronic inflammation, improve overall wellbeing and boost energy levels.

  See Food for Thought: Diet and Nutrition for a Healthy Back

With an absence or plateau in improvement, treatment may need to be changed or other therapy options introduced. Chiropractors often coordinate care with allied healthcare providers when services are not available or offered In-house.

Treatment Program Questions

Questions to ask about the specific chiropractic treatment plan for back pain, neck pain or other symptoms may include the following:

• What is the chiropractor's typical practice pattern or treatment program?
• What chiropractic services does the chiropractor offer? Some chiropractors offer additional services, such as massage, exercise instruction, rehabilitation and strength training, and nutritional counseling.
• What is the chiropractor's recommendation if the treatment program doesn't seem to help? A good chiropractor will recommend that the patient consult another practitioner, particularly if other treatments are indicated (such as injections, medications or surgery).
• Has the chiropractor ever referred any patients to other health professionals? If yes, under what circumstances? Ask for case examples.

It is important to understand the chiropractor’s anticipated timeline for the treatment plan, and what would be done in case the treatment goals are not being met.

See Chiropractic Services Beyond Adjustments

Potential Red Flags about Chiropractic Treatment Programs

There are a few elements of chiropractic treatment programs that most chiropractors agree are questionable. Examples include:

• Manipulation of symptom-free areas of the spine. As a general rule, a chiropractor should not manipulate areas that do not have symptoms. For example, a chiropractor will not manipulate the patient's neck if the patient has a lower back problem only.
• Treating all patients the same. It is advisable for patients to avoid practitioners who tend to find the same thing wrong with every patient and treat every patient with the same treatment program.
• Long-term treatment programs. Patients need to be cautious if a chiropractor recommends a lengthy chiropractic program after just 1 or 2 visits, such as lasting 3 months or more. The majority of patients will find significant pain relief within several weeks of treatment. When symptom relief is not experienced within this time period, another treatment approach—possibly by a different health provider—is likely warranted.

The bottom line for patients is to exercise their judgment in choosing a good chiropractor—the same as when choosing any type of health care practitioner.