Chiro dosing.pdf 

Chiropractic Dosing:

How many treatments do you need, how often, and how close together?

Over the last decade or so, healthcare has been moving towards Evidence Based Medicine. For those not familiar with this term, it may seem obvious that healthcare should be provided based on what works best. After all, aren’t all medical recommendations based on scientific studies? Sadly, unless your doctor makes the commitment to stay on top of the ever growing number of scientific studies published daily, he or she may make recommendations that are based on his or her habits and routines rather than on the latest research studies. If you are lucky, recommendations based on opinion may be the same as those based on medical evidence. In our office, we have made the commitment to continually update our practices and procedures to make certain that we offer you, our patients, the best, most effective and safest care possible. With this in mind, I’d like to share several recently published studies with you concerning the care you receive at our office. Several landmark studies have recently been published detailing the best, most effective "dose" of chiropractic therapy. As with all types of therapy, the optimal dose and schedule of care will determine the amount of success you, as a patient, obtain from the treatment you receive. Simply put, adhering to the proper dose and schedule of care will produce better results than a random schedule of care administered in a haphazard manner.

Our Treatment protocols are based on the latest scientific research:

This evidence-based approach ensures you will get the best, most effective and safest form of care available for your condition.

So what is the best dose and schedule to ensure the best possible outcome from you care? For the treatment of neck pain and/or headaches, those patients who received 9-12 chiropractic treatments over a 3 week period responded much better than those patients receiving 3 visits (1 treatment per week) 1 Likewise, for lower back pain, those patients who were treated 3-4 times per week for three weeks had much more improvement than those patients treated weekly. 2 Clearly, the research shows that multiple treatments (3-4 times per week) over a three to four week period is the best, most effective dose for chiropractic treatment. This true for headaches, neck pain and lower back pain. 1-2

Preventive Maintenance Care: Is it really worth it?

What about follow-up care and preventative care?

It is common for chiropractors to recommend follow-up visits, to correct spinal problems, enhance bodily function and most importantly to prevent future ill health. 5,6 The latest research supports a follow-up schedule after the initial intense treatment dose. 3 This research re-affirmed that an inital 9-12 visit dose of chiropractic care improved pain and reduced disability in patients with lower back pain. Additionally, they found that follow-up or maintenance care over the next nine months resulted in (at a dose of 1-2 treatments per month) was beneficial to patients in terms of lessening disability and preventing the return of back pain. 3 Still another study suggests that mainenance dose of chiropractic care was actually able to improve general health and well being as measured on the MOS-SF36. 4 The MOS SF36 is an instrument used to measure physical, emotional and other health and well-being characteristics. This study suggests that even after the pain is gone, a monthly dose of chiropractic care can actually improve overall health and improve your ability to function.Using the best available evidence on chiropractic dosing, we will be recommending..

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1. Treatment 3-4 times per week for three weeks.

2. Follow-up visits 1-2 times per month for an additional 9 months.

3. With the additional recommendation for regular preventative visits to improve your general health and well being.

See references 1-4

So is it really worth continuing on with chiropractic care even after you are feeling better? Some interesting data is emerging regarding the benefits of chiropractic maintenance care programs. 7,8 Senior citizens who kept up with regular chiropractic care were less likely to have been hospitalized, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously , and more likely to be mobile in the community. In addition, they were less likely to use prescription drugs. 8 Likewise, younger patients in an HMO who utilized chiropractic care had their surgery rates reduced by 32-49%, they had 25-37% less need for MRI/CT scan studies and had their hospitalization rates reduced by nearly 50%, depending on the type of problem they were experiencing (neck or lower back pain) 7 So after an initial three to four week course of intensive chiropractic treatment, we will be recommending additional once a month visits over the course of nine months. After you complete this evidence based treatment plan, you have the option to continue on for preventative maintenance care. This dosing plan will offer you the best opportunity to regain and maintain your health.

The studies we use to provide our recommendations for your care

1. Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study, JMPT 2004 Nov-Dec; 27 ((): 547-53

2. Dose-response for chiropractic care of chronic low back pain. Spine J. 2004 Sep-Oct; 4 (5): 574-83.

3. Efficacy of preventative spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. JMPT 2004 Oct;27 (*):509-14.

4 Chiropractic maintenance care and quality of life of a patient presenting with chronic low back pain. JMPT 2005 Feb;28(2): 136-42

5. A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I. JMPT 2000 Jan;23(1):1-9

6. Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II. JMPT 2000 Jan;23(1):10-9

7. Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain JMPT 28(8)Oct 2005: 564

8. Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program Topics in Clinical Chiropractic 1996 (Jun):3(2): 46-55