Unlike a prescription drug, there are no “dose response’ guidelines for spinal manipulation (AKA the Chiropractic Adjustment). What’s a dose response? That’s how much of a medicine/treatment is required to see a change. Let’s say you have an infection. Take this pill three times a day for 7 days and the infection will clear up. The dose is 1 pill 3x/day for 7 days. The response is the infection being cured. Dose response.
We don’t have that in manual medicine because there are way too many variables. A person who is older, larger, or sicker will take longer to heal than someone who is younger and healthier. And everyone and every body responds a little bit differently. A chiropractor who doesn’t use exercise or electrotherapy won’t get results as quickly as one who does. Skill levels matter and so do injury types. A weekend warrior with a kinked back takes less visits to fix than someone who has been in a car crash. Some conditions like stenosis require long periods of regular care to keep symptoms under control. But even then, there are many Chiropractors here in Portland with diverse backgrounds and clinical beliefs. One person shopping for a chiropractor could get different answers for the same problem.
But the industry needs some general agreement or standardization so we rely on guidelines that tell us generally how long someone should need to be treated for an injury based on the kinds of structures injured (muscle, bone, tendon, ligament) and the severity of the injury (mild, moderate, severe). And someone with enough experience can typically give you a very close guess just based on your presentation. It’s been my experience that most “simple” things can be fixed in under three visits (if the goal is merely pain control) while a bad car accident could take between 3-12 months depending on the severity.
Very recently, researches with the University of Western States here in Portland went out to see how many visits it would take to help someone with chronic low back pain. It’s the first study of its kind and it’s sure to have many implications on the industry. First, let’s define chronic low back pain (CLBP). CLBP is pain lasting longer than three months without any known cause. All the tissues are healed and there’s nothing that anyone can find that could be causing the pain. It’s just pain for pain’s sake.
They looked not only at pain levels but at function too. Because many people with CLBP don’t mind the pain if they can at least get back to doing what they love like hiking around Portland or riding their bike. What they found is that if adjustments were the ONLY treatment (no rehab, ultrasound, tens, etc.) then it would take 12 visits dished out at three times a week for four weeks to make the greatest effect on pain and function levels and the improvements were maintained for up to a year. Anything beyond 12 visits didn’t improve things to a greater degree. They also found that pain levels didn’t decrease little by little after each treatment but rather the levels dropped dramatically after six visits.
Whereas no one can say with any certainty that that your condition will be improved with X many visits, doctors can rely on industry guidelines and experience to offer an educated guess. In cases of chronic low back pain, the best educated guess is now about 12 visits at three times a week for four weeks but of course this will depend on a patient’s complicating factors and prior state of health.