How Long Do You Need to Get Treated?

Mechanicsville, Virginia — At Stover Chiropractic I’m almost alway asked, “How long will it take until I’m going to feel better?”  Or, “How many treatments is it going to take to get better?”  I learned some interesting information from Dr. Stuart McGill’s book, Low Back Disorders: Evidence-Based Prevention and Rehabilitation.  In a section titled: Can Back Rehabilitation Be Completed in 6 to 12 Weeks? Dr. McGill makes some great points are relevant to the questions patients ask.  This information can help inform and instruct both me and my patients about expectations.

Dr. McGill explains the idea of a 6 to 12 week rehabilitation time seems to have originated from animals  (reviewed in Spitzer, 1993).  The problem is not all human patients get better so quickly.  Evidence shows mechanical and neurological changes linger for years subsequent to injury.  This includes various motor control parameters with muscle atrophy and other disorders.  It is not just a matter of gross damage healing that should be included in evaluating treatment plans.  Plans should be made while considering the reality of the following studies.

- Ligaments have been shown to take years to recover from relatively minor insult (Woo, Gomez, and Akeson, 1985).

- Many reports have documented the cascade of biomechanical change associated with initial disc damage and subsequent joint instability and secondary arthritis, which may take years to progress (e.g. Brinckmann, 1985; Kirkaldy-Willis, 1998)

- Vertebral osteophytes (bone spurs) were most highly associated with end-plate irregularities and disc bulging (Videman and colleagues 1995)  The spurs are generally accepted to be secondary to disc and end-plate trauman but take years to develop.

Thus, back pain that lingers for more than a few months very much mechanically based.  The chiropractic subluxation fits this model perfectly.  Chiropractors have said for years that complete correction from a long standing subluxation, with secondary degeneration (osteoarthritis) will often take months and up to two years to heal.

Dr. McGill asks the question, “Can these back troubles linger for a lifetime?”  He makes the interesting observation that the elderly appear to complain less about back pain than young folks.  It appears the cascade of changes that lead to pain generally does not last longer than 10 years (and who wants to wait that long).  McGill starts to sumarize with an important qualification, “although the bad news is that the affected joints stiffen [my emphasis] during the cascade of change, the good news is that eventually the pain is gone.  To summarize, the expectation that damaged low back tissues should heal within a matter of weeks has no foundation.”  “Troublesome back are generally not a life sentence.”

This is encouraging in some ways and very insightful as to what to expect.  That is, healing a spine is slow.  But please understand what he is saying.  He says the PAIN is not a life sentence.  Stiffness, poor posture, and vertebral subluxations and the associated neurologic impact will remain.  These are different problems.  Dr. McGill never said the joint stiffness in the cascade of changes would go away.  It is that stiffness that correlates to chiropractic subluxations.  For that reason, we need to be diligent over a lifetime to maintain healthy spines and nervous systems with good “spinal hygiene.”