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Do I Need To Go To A Chiropractor Three Times Per Week?

Chiropractor in Amarillo, TX, Dr. Jeff Williams, breaks it down for you. 

I think it is important to begin by saying the chiropractic profession, unfortunately, is not very standardized. For example, if you have an ear infection in Dallas, Portland, New York City, or Davenport, Iowa, you have a good idea of what kind of treatment you will get before you even go in. The medical field, while still having outliers in their system, is fairly standardized. They mostly follow protocols and guidelines put forth with the expectations that they will be followed for the best patient care and patient outcomes. 

The chiropractic has guidelines and best practice recommendations put forth based on research and the best current evidence as well. However, by and large, it seems to be up to the individual practitioner as to whether they are going to follow them or not. It has been my experience after over two decades in the profession that it is not well-standardized or very well-governed unless some sort of a complaint is made by a patient. 

For this reason, we really have three ‘factions’ in the profession. I have discussed these several times in past articles. Briefly, they are, in my admittedly extremely biased view, as follows:

  1. Evidence-based, patient-centered - This is the camp we fit into in my clinic. I am a self-professed ‘research nerd’ and I mean that in every good sense of the term. Evidence-based, patient-centered means the doctor uses the latest, most current research to formulate their diagnosis, treatment, and protocols. This type of doctor will forgo protocols that will make them and the clinic much more money but is not necessarily in the best interest of the patient or the patient’s pocketbook. Rather, they only do what research says should be helpful and aid the patient in becoming able to self-manage their complaint at home without depending on seeing the chiropractor for multiple visits for the rest of their lives. THAT’S the essence of patient-centered care. 
  2. Agnostic - These chiropractors received a great education and now they are simply going about their day-to-day business just treating patients without much concern about research, guidelines, or anything of the sort. They are basically in the middle and really don’t care much about furthering their understanding, or research, OR of the philosophy side of things. They are just there. That does not make them 'less than' as far as how good they are. Some are better than others for sure. 
  3. Subluxation/Philosophy- I make no friends in my profession by discussing these things. It is a bit uncomfortable for me to be honest. But, if I am to contribute to the public's understanding and better my profession for future generations in the process, it is my opinion that it is necessary. Subluxation/philosophy chiropractors still maintain and believe in the ideas the profession was built on or invented around more than 120 years ago by the profession's founder. Regardless of the lack of research over those 120 years to support their claims, the belief in the founding principles remains. The belief is that continuously removing ‘subluxations’ from the spine frees the nerves to operate with their full potential. This, to them, means the patient will never have disease, does not require any vaccinations since they’ll never get sick anyway, and should be pain-free. If a patient visits a chiropractor approximately once per week for eternity. These folks are not necessarily trying to be doctor-centered but, when the clinic makes money hand over fist and the recommendations they make are contrary to the most widely accepted guides and recommendations for the best patient care….well, I suppose patients can decide what they think is best for themselves as long as they are educated on the differences. 

The reason for covering the three groups is because each will likely provide different recommendations for your treatment schedule. That speaks directly to whether you really need to go to a chiropractor three times per week or not. 

While I cannot say exactly what a chiropractor in the middle (agnostics) would recommend as far as treatment goes, I have a very good idea of what evidence-based chiropractors and subluxation-based chiropractors typically recommend. 

A good chiropractic care schedule

I believe most evidence-based chiropractors would agree that regardless of whether it is chronic or acute pain, an initial trial period of three times per week for two weeks is appropriate and makes good sense. Think about it for a moment; the pain is most typically musculoskeletal pain. Anything based around the musculoskeletal system simply takes time to change. If you sign up and start going to the gym, any work you put in is going to take at least two weeks to begin showing signs of change. If you go to a physical therapist, you will most certainly get recommendations for multiple visits per week for several weeks. Usually much longer than just two weeks and typically at much more expense per visit. 

For these reasons, a short initial treatment plan is more than responsible, appropriate, and within common best practice guidelines. After the initial 2 weeks, if the patient is feeling great and has improved signficantly (which is usually the case), it is appropriate at that time to reduce the frequency to two visits per week for a week or two, and then reduce it further to once per week for a week or two beffore finally releasing the patient to self-manage any further flare-ups at home.

If the patient has chronic, long-standing pain, treatment may be more lengthy and a bit more involved. 

Most patients respond very favorably to this sort of recommendations. I typically tell patients that basically, the better they’re feeling, the less I want to see them. I tell them I make recommendations to them that I would make to my own family members. When we go about business in that way, everything else, including finances, just sort of take care of themselves. 

It has been my experience that the sbuluxation-based chiropracorrs typically make very long-term recommendations. Multiple visits over a long period of time. For example, they place a high value on whether a patient has a decreased curvature on their neck x-ray. They believe this puts a patient at great risk of developing major issues as they age. But, long-lasting (20 years in duration), well-done research suggests a decrease in neck curvature has little (if any) impact on a patient over the years. Yet, you commonly see cases in which these chiropractors recommend up to 70+ visits costing upwards of $3500-$5,000 in treatment costs in just a year in an attempt to correct this curvature issue. Some call their patients 'practice members' rather than patients and require them to sign treatment contracts and things of that sort. When the research says a decreased neck curvature probably doesn’t matter and as for the contract....well, in my opinion, there is simply no place in healthcare when a contract is appropriate. It creates a barrier of sorts between the doctor and the patient. A sense of distrust if you will and it is not something I would ever recommend a patient sign. In fact, outside of personal injury legal paperwork, I would recommend patients run out of the clinic as fast as possible if ever confronted with a practitioner of any kind attempting to bully them into a contract for treatment. 

Beyond the curvature issues, many subluxation-based chiropractors will commonly urge patients to visit them 2-4 times per month for the course of their lifetime. That would be 24-48 visits per year forever. There is no reputable research that I am aware of backing up that kind of treatment. And remember, I’m a research nerd and have been in the profession for over 2 decades. For that reason, if it were out there, I would have probably come across it by now. There is a compelling argument to be made that that many treatments of spinal manipulation over the course of a certain amount of time could potentially lead to spinal instability. Which means it could do more harm than good. It is definitely something to consider when making your decisions. 

What's the verdict on chiropractic care frequency?

So, is do you have to go to the chiropractor three times per week? Nobody can force you to do anything you do not want to do. You are the patient and patient preference plays a big part in evidence-based care and best practices. However, if you have a complaint that you really want resolved, an initial trial treatment schedule of three times per week for two weeks is completely recommended, appropriate, and responsible. Beyond that, again, it is purely patient preference as to what you believe and what your chiropractor recommends.

Hopefully, though, I have given you some ideas on how you should be responsibly directed in an evidence-based, patient-centered manner. 

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Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast. Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected]

Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109