Persistent back pain sucks. As a chiropractor and someone who has dealt with back pain for years, I understand how persistent back pain can not only be physically disruptive, but also confusing and at times concerning. In recent years we have started to see back pain not simply as a one-time occurrence but as a long-lived condition with peaks, valleys and natural fluctuations. This is termed a relapsing-remitting clinical course and means that there will likely be periods where things feel good but also periods where the back pain can flare up. For a clinical course such as this, it is important to understand that re-occurrence of back pain is likely, even after a single bout has completely resolved. This is backed up by research that tells us that roughly 80% of the world’s population will experience at least one bout of back pain in their life.  Roughly 80% of those that have one bout will go on to have at least another occurrence of back pain after the first bout1. This can be frustrating to hear, but the good news is that treatment can help manage this course, even if it does not stop it for good. Treatment can help to prolong pain-free periods while reducing pain intensity and increasing function during flare ups and for some people, this can be achieved through chiropractic maintenance care.

I often get questions about maintenance care as well as skepticism as to whether it is necessary or not. You, like many others, may ask “Why do I need to come in for treatment if nothing hurts?”, and that would be a very good question. While maintenance care does have research supporting it (I will get to that later), allow me to provide a quick metaphor for you: we can look at chiropractic maintenance care as we look at regular dental visits. This is not a perfect metaphor by any means (most metaphors aren’t), but there are a couple of parallels that can be seen. I am no dentist, but I think it is safe to say that regular dental visits help to keep your teeth healthy while checking to ensure nothing serious is going on so we can (hopefully) avoid any major problems that would require expensive surgeries or cause disabling pain. Chiropractic maintenance care does the same thing but for your muscles, joints, and nerves. Just like your dentist will check in with you at a regular visit, we as chiropractors will check in with how your body is feeling and how you are moving at a regularly scheduled maintenance visit. Just like your dental hygienist will scale, floss, and polish your teeth, we as chiropractors will provide manual therapy to help “clean up” anything we do find in our assessment to keep you on track or nudge you back in the right direction. And finally, just as your dentist provides you with dental advice, we as chiropractors will provide you with advice on activity or lifestyle modification, prescribe exercise, and answer any questions you may have so that you are given the best tools to work on your body’s health between visits. It’s all about giving you what you need to live the healthy, active lifestyle you desire.

Just in case you aren’t a fan of metaphors, there is good, current research to support chiropractic maintenance care in the management of persistent back pain. A study in 2018 took 328 patients with persistent low back pain and compared a maintenance care program to a symptom-guided program2. The maintenance care program had patients scheduled in with the goal of receiving treatment before pain recurred, at the discretion of the clinician, but with at least 1 appointment every 3 months. The symptom-guided program had patients schedule themselves in only after their pain recurred. Over a 1 year period, patients who received maintenance care saw significantly faster improvement and significantly less days with bothersome back pain than those who received symptom-guided care with only 2 more appointments in that 1 year period2. This is a great bit of research to show that regularly scheduled visits for chiropractic treatment before you feel pain can significantly improve the course of persistent back pain.

If I can summarize all of this in one piece of advice for anyone looking for help managing persistent back pain, it would be to not wait until it is too late and to instead try to seek treatment before things feel bad. Take control of the course of your back pain!

If you are interested in chiropractic maintenance care, book a chiropractic appointment today to find out if a maintenance plan is right for you!


Dr. Cory Niedjalski


Rebound Sport and Spine




  1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-2367. doi: 10.1016/S0140-6736(18)30480-X. Epub 2018 Mar 21. PMID: 29573870.


  1. Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, Bodin L, Axén I. The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain-A pragmatic randomized controlled trial. PLoS One. 2018 Sep 12;13(9):e0203029. doi: 10.1371/journal.pone.0203029. PMID: 30208070; PMCID: PMC6135505.