For acute low back pain, 6 to 12 sessions over the course of 2 to 4 weeks is standard. These initial treatments do emphasize the "passive" (nonexercise) approaches of manual therapy to relieve pain and improve function. As quickly as possible, more "active" (exercise) can be utilized to increase function and ultimately return a patient back to his or her daily life.

What if the Pain Doesn't Go Away?
Many times acute symptoms do resolve within the first trial, 4-week period. However, it is also possible the pain can become chronic, lasting past 12 weeks.

Some patients simply may reach a plateau in their recovery process, referred to as MTB (met therapeutic benefit). A chiropractor would want to see if withdrawing from chiropractic treatments, then has a residual effect, exacerbates the pain and/or reduces function and activity performance. If so, a management regimen may be necessary.

For example, if mild to severe chronic pain is exacerbated, a patient may have 1 to 6 more visits per episode, at 2 to 3 weekly treatments for 2 to 4 weeks. Rarely, patients may need ongoing care of 1 to 4 visits per month.

The Importance of Reevaluation
Clinicians are not going to continue chiropractic treatments if they are not helping the patient. Because of this, every 2 to 4 weeks, a chiropractor revaluates the patient to see if the chiropractic treatments still are having a beneficial effect.

These are some of the criteria for continuing treatment for chronic low back pain:

• The patient still has a favorable response to treatment
• The patient has reached MTB and worsens when not treated
• There is proof that self-care alone will be insufficient to maintain MTB

Continuing Treatment
Living with chronic low back pain is a challenge, but chiropractors want to emphasize to patients that self-therapy is a vital component of pain management. This can include rehabilitation and range of motion exercises. However, chiropractors also may encourage more multimodal approaches, incorporating acupuncture, massage therapy, yoga, lifestyle and psychosocial counseling, and many more treatment options that can be very beneficial. The treatments used and the benefits gained can vary with every individual, which is why it is important to be in a proactive, communicative relationship with the chiropractor.

This series of articles about chiropractic care for low back pain contains information cited from a recent update in recommended treatment guidelines published by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). All authors and panelists involved in the publishing of the new updated guidelines stated receiving no compensation from any organization. There were no conflicts of interest reported.