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Countless number of times patients ask me if they should see me regularly for “maintenance” visits.  Perhaps surprisingly, my answer is rarely an absolute “yes”.  First, and foremost, the patients that ask this question are often the ones I just met who have sustained an injury. Whether it is back pain of mechanical origins, neck pain, recent bout of headaches, a sore knee, or whatever, the issue of maintenance is putting the cart before the horse.  Resolution and recovery from the injury is our first priority.  This can sometimes take a few visits to a few weeks or months.  Maintenance does not enter the picture until we are actually trying to “maintain” something that we’ve achieved.

Let’s Talk Maintenance

Assuming the original injury is healed, we can now talk maintenance.  Logic suggests that if manual therapy, such as chiropractic, helps the body to recover from an injury, then it should help to prevent the injury.  I subscribe to this logic, but there is not a ton of scientific evidence to support it.  Just because we have not conducted research on maintenance, though, should not refute its value.  So, I do engage my patients in the important discussion of how to “maintain” the body’s status.

Maintaining a certain status requires effort to actually be better than we are.  If we’re standing still, we’re moving backwards.  Time takes a toll on our body so if we’re not progressively trying to be better, we’re actually going to get worse.  So, maintenance takes many forms: Exercise, nutrition, mindfulness, relaxation, treatment, etc.

But, how much treatment?

I typically let my patients figure this out for themselves.  I don’t pull a piece of paper out of my desk drawer and read the line about “maintenance” treatment schedules.  Rather, I’ll suggest a certain time frame for when the patient should return, and then see how the patient has done during that time period.  If well, we may increase the time between visits; if not, we may decrease the length between visits.  Trial and error works well for figuring out a good timetable for when the body needs a “tune-up”.

Save Money with Maintenance

Cost and insurance funding becomes an extra wrinkle to figuring out when to come back too.  For instance, some patients like to skip “maintenance” in favour of saving their insurance dollars for the next “injury”.  I respect this line of thinking from a financial point of view.  From a clinical point of view, it doesn’t hold much logic though.  Maintenance should lead to less occurrences of pain and injury and, in turn, less need to save money for those times.  In my 11 years of practice, I’ve observed, without fail, that my healthiest patients are the ones that visit me routinely – whatever that routine is, and whatever you want to call it.  We call it maintenance.

As always, comments and questions welcomed.

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