A key component of chiropractic care is to re-evaluate the treatment plan every few weeks. By periodically re-evaluating how the patient’s symptoms are improving or progressing, decisions can be made about whether to continue, change, or stop chiropractic treatment or refer elsewhere.

Changes to Treatment Approaches

If the patient is not getting pain relief after the first few weeks of chiropractor treatments using spinal manipulation and/or spinal mobilization, a chiropractor will typically consider other alternatives.

Common changes that may be made to a chiropractic treatment plan include:

  • Changing the therapeutic/treatment technique, followed by a re-evaluation.
  • Changing the treatment frequency.
  • Consider x-rays if not taken initially.
  • Evaluate lifestyle ergonomics that could be contributing to ongoing symptoms.
  • Adding or modifying a home exercise or stretching program.
  • Co-managing the patient with other allied healthcare providers, such as a physiatrist, osteopath, orthopedist, and/or physical therapist.
  • Referring to another health care provider or an integrated spine clinic.
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A good chiropractor will usually have strong working relationships with other health professionals in their area, including spine surgeons, physical therapists, massage therapists, physiatrists, and pain management specialists.

Patients are well advised to look for a chiropractor who routinely coordinates patient care with these types of health professionals, either as part of an informal network—referring patients to other doctors and health professionals that they trust—or as a part of an integrated network or spine clinic.

See Potential Benefits of Integrated Spine Clinics

When to Discontinue Chiropractic Care

In general, it is advised to discontinue chiropractic care if any of the following is true:

  • Increased pain. It is not uncommon to note mild discomfort after the initial manipulation treatment for the first 24 to 48 hours (similar to starting a new exercise). Beyond that, if the patient has increased pain during or following spinal manipulation, the chiropractor needs to stop and re-evaluate the treatment plan immediately.
  • No improvement within 2 to 4 weeks. For back or neck pain that has not started to feel better after 2 to 4 weeks of chiropractic care, other treatment options and/or diagnoses need to be investigated.
  • Symptoms have gone away. While some chiropractors may offer maintenance manipulations to help prevent pain from recurring, the evidence for this practice is weak.1,2 Spinal manipulations should not be continued indefinitely. Also, most insurance carriers do not cover chiropractic maintenance care.
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Many people have reported musculoskeletal pain relief from spinal manipulation and/or spinal mobilization performed by a chiropractor or other qualified practitioner. When manual treatments do not provide the expected relief or benefit, it is good to re-evaluate and reconsider the treatment.

References

  • 1.Iben A, Lise H, Charlotte LY. Chiropractic maintenance care – what’s new? A systematic review of the literature. Chiropr Man Therap. 2019 Nov 21;27:63. doi: 10.1186/s12998-019-0283-6
  • 2.Charlotte LY, Hestbaek L. Maintenance care in chiropractic – what do we know? Chiropr Osteopat. 2008; 16:3. doi: 10.1186/1746-1340-16-3
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