A Theoretical Basis for Maintenance Spinal Manipulative Therapy for the Chiropractic Profession
SOURCE: J Chiropractic Humanities 2011 (Dec)
David N. Taylor
Director, Multimed Center, Inc., Greenfield, MA
The World Health Organization defines health as being “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. [ 1 ]
Given this broad definition of health, epistemological constructs borrowed from the social sciences may demonstrate health benefits not disclosed by randomized controlled trials.
Health benefits, such as improvement in self-reported quality-of-life (QOL), behaviors associated with decreased morbidity, patient satisfaction, and decreased health care costs, are reported in the following articles, and they make a compelling statement about the effects of chiropractic on general health.
OBJECT: The purpose of this article is to discuss a theoretical basis for wellness chiropractic manipulative care and to develop a hypothesis for further investigation.
METHODS: A SEARCH OF PUBMED AND OF THE MANUAL, ALTERNATIVE, AND NATURAL THERAPY INDEX SYSTEM WAS PERFORMED WITH A COMBINATION OF KEY WORDS: chiropractic, maintenance and wellness care, maintenance manipulative care, preventive spinal manipulation, hypomobility, immobility, adhesions, joint degeneration, and neuronal degeneration. Articles were collected, and trends were identified.
RESULTS: The search revealed surveys of doctors and patients, an initial clinical pilot study, randomized control trials, and laboratory studies that provided correlative information to provide a framework for development of a hypothesis for the basis of maintenance spinal manipulative therapy. Maintenance care optimizes the levels of function and provides a process of achieving the best possible health. It is proposed that this may be accomplished by including chiropractic manipulative therapy in addition to exercise therapy, diet and nutritional counseling, and lifestyle coaching.
CONCLUSIONS: It is hypothesized that because spinal manipulative therapy brings a joint to the end of the paraphysiological joint space to encourage normal range of motion, routine manipulation of asymptomatic patients may retard the progression of joint degeneration, neuronal changes, changes in muscular strength, and recruitment patterns, which may result in improved function, decreased episodes of injuries, and improved sense of well-being.
The Full-Text Article:
The chiropractic profession continues to grow in collective thinking and progress in defining care rendered. In so doing, the profession participates in the investigation of the types of care rendered and in the translation of research into practice. Different types of care are developed from theories, clinical practice, and clinical observations and, ultimately, based on scientific evidence. However, certain types of chiropractic care are the subject of debate. This article considers the scientific basis of the commonly practiced procedure of chiropractic maintenance care and whether a hypothesis of a physiological basis can be generated to explain findings and practice.
Recent publications by the Council of Chiropractic Guidelines and Practice Parameters have summarized clinical best practices for chiropractic care and identified some of the changes that chiropractic clinicians need to make to improve care for their patient population.  Two articles [ 2, 3] give us insight into the types of care rendered. Dehen et al  defined the stages of chiropractic care into care for acute and chronic/recurrent conditions, and wellness care. A distinction is made between the chronic/recurrent care and wellness or maintenance care. Care for chronic/recurrent conditions is defined as medically necessary care for conditions that are not expected to completely resolve, but in which one can provide documented improvement. According to Dehen et al, wellness or maintenance care may not be defined as being “medically necessary” for a current condition. However, this type of care optimizes the levels of function and provides a process of achieving the best possible function and health. This care includes chiropractic manipulative therapy in addition to exercise therapy, diet and nutritional counseling, and lifestyle coaching.  This concurred with surveys made by Danish and Swedish chiropractors who defined the purpose of chiropractic maintenance care as optimizing spinal function and decreasing the frequency of future episodes of back pain.  Various definitions have been provided for maintenance care:
(1) “Appropriate treatment directed toward maintaining optimal body function. This is treatment of the symptomatic patient who has reached pre-clinical status or maximum medical improvement, where condition is resolved or stable”;
(2) “a regimen designed to provide for the patient’s continued well-being or for maintaining the optimum state of health while minimizing recurrences of the clinical status”; and
(3) “maintenance care was offered to patients that did not improve.”