The results are in. More IS better.

How many chiropractic treatments are enough?
by Dr. Joseph Pigg, D.C.

This is usually the number two question after "Can you help me with my problem?". Previously chiropractors relied on a combination of their own personal results for various conditions and a basic knowledge of healing times for injuries. There is some disagreement within the profession as far as specific protocols for how often and for how long someone needs to come in.

But in 2004, M. Hass, D.C. and Groupp, PhD published an exciting study in the Journal of Spine 4(5): 574-83 showing results from a randomized clinical trial on this very issue.


They took people with long time lower back pain and put them into several groups. One group received spinal manipulation and the other received spinal manipulation plus passive modalities (heat/ice, ultrasound, electric muscle stimulation, etc...) Each group got different amounts of care. 1, 2, 3, or 4 visits per week over a period of 3 weeks.


There was not much difference between the people getting chiropractic treatment 1 or 2 times per week, but a big jump in pain improvement for the people in the 3-4 times per week groups. This suggests that more chiropractic treatments may be required to reach the optimal benefit.

There are cases where the patient is able to get away with less visits when the doctor can clearly see that a quicker recovery is expected.

Too often, I am reluctant to recommend a large number of treatments because I anticipate the patient may not comply with the recommendations due to scheduling difficulties, financial barriers, or lack of motivation. And sadly, many HMO insurance plans and Kaiser only allow 5 visits for an episode of pain in spite of the fact that research like this clearly shows the most benefit came from approximately 9-12 treatments. As a doctor in practice, it is great to have this research to support my recommendations. It is what we call "Evidence Based Practice". Meaning that we don't make random recommendations or suggest numbers of treatments because they might be nice sounding numbers, but rather based on research and clinical trials that show evidence of a real benefit following a certain protocol.


There are some patients that I have been working with for a long time who are seen very seldom where we aren't getting the results we want and we try a 2-3 week period of very frequent adjustments to "move it up a notch". In almost every case, there has been a drastic improvement during this trial period and it makes the future maintenance care much easier.


If you are one of my patients and think you might benefit from a temporary increase in care, call or email me and let's talk about whether you would be a good candidate for more aggressive care.

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