How Often to See a Chiropractor, and When to Stop

There are two versions of this question and I get both.

The polite one is “how often should I be coming in?” The real one usually arrives near the door, slightly sheepish: “So… do I have to keep doing this forever?”

No. You don’t.

I’ll answer the frequency question properly, because everyone asks it. But it’s the less useful of the two questions available to you, and by the end of this article I’d like to have talked you into a better question.

How often should you see a chiropractor?

There is no fixed schedule, and it all depends on the person in front of me. Part of my role as a chiropractor in Victoria is to give you an idea of the probable timeline for what you are seeking help for. This is typically the natural progression. After the initial visit I will likely follow up with you in the first 1–2 weeks to make sure you are responding well, and nothing new has come up. My goal is to manage all cases giving you the most autonomy, so there is no practitioner reliance created.

What surprises people is how little the precise number seems to matter. The best trial on this took 400 people with chronic low back pain and randomized them into groups divided by 0, 6, 12, or 18 manipulation sessions and followed them for a year.¹ The benefit levelled off at around twelve sessions — past that, extra visits bought very little. A wider review of the dosage research is blunter: no optimal frequency has ever been established.²

More is not better. Past a sensible point, additional visits mostly buy you additional visits.

What happens if you stop going to the chiropractor?

Nothing. Your spine will not drift out of alignment because you stopped booking. It will not deteriorate. You do not become dependent on adjustments, and stopping is not a risk you’re taking.

I want to say that plainly, because the worry is real and my profession has done something to earn it. Chiropractic carries a reputation for care that goes on and on, and I’d rather meet that head-on than pretend it isn’t part of why you’re reading this.

I also know that worry from the other side of the table.

It is still present in my life, but the flares are rare. I’m able to acknowledge the disappointment and anxiety that naturally sparks, without having it impact my mental health, because I know it’s going to disappear again soon. 

The idea that people who feel fine need ongoing adjustments to stay fine has never had good evidence behind it. Even the most favourable review in my own field’s literature supports scheduled care only for a narrow group: people with a history of back pain episodes who already responded well to treatment.³ It says nothing about adjusting well people indefinitely to keep them that way. That was never the claim the research made.

The better question: what is the appointment for?

Here’s where I’d rather we ended up, because “how often” turns out to be the wrong axis entirely.

Scheduled maintenance care — booking in advance at set intervals, whether or not anything hurts — does work, and I want to be fair to it. The best trial found that people on a pre-planned schedule had around thirteen fewer days of bothersome back pain over a year than people who came in only when it flared, and for those whose pain was frequent and genuinely limiting, closer to thirty fewer days.^4,5 If your back runs your life, that is not nothing.

But read the same trial to the end. After a full year of scheduled care, those patients were still in pain roughly a quarter of the year. The treatment reduced their bad days. It did not get them better. Nobody in that study recovered — and it was never designed to.
That’s the thing I want you to see. Maintenance care is aiming at your symptoms, and it’s decent at what it aims at. But it isn’t aiming at getting you out of care, and it was never going to land somewhere it wasn’t pointed.

So what happens when you aim somewhere else?

And a 2023 trial did something similar with a single well-designed approach: about seven sessions teaching people to understand their pain, move through what they’d grown afraid of, and manage it themselves. The improvements were large for this field, and those improvements were still there three years later.⁷ Seven sessions. Roughly the same number of visits as a course of maintenance care. An entirely different goal.

None of which makes hands-on treatment worthless — I’d be out of a job, and I don’t believe it for a second. Across 249 trials and more than 24,000 people, manual therapy came out about level with exercise for chronic back pain. Neither better nor worse.^8,9 It works. It just isn’t a category apart, and it isn’t enough on its own, which is why the national guidelines in the UK recommend manual therapy for back pain only as part of a package that includes exercise.¹⁰

So here is the line I’d most like you to leave with. The evidence isn’t an argument against chiropractic. It’s an argument against the adjustment on its own.

Those aren’t the same thing, though I understand why people assume they are. Chiropractic is a scope of practice, not a single technique. My training covers rehabilitation, exercise prescription, and how to explain pain to someone who has grown frightened of their own back — as much as it covers how to adjust a joint. The adjustment is only one tool in the bag. It just happens to be the one that got the marketing budget.

So here is what I actually believe, and why my practice looks the way it does. The thing that needs maintaining is your capacity — your strength, your tolerance for load, your confidence that your back can be trusted with a heavy bag and an awkward lift and a long drive. An adjustment can reduce pain, restore movement, and get you to the point where you can do that work. What it cannot do is store any of it up on your behalf.

When ongoing care makes sense

None of this means standing appointments are always wrong. Here’s when I’ll actually raise the idea:

• Your pain is recurrent and fairly predictable — back every few months, often for reasons you can name
• You responded well to hands-on care the first time round
• Your work or your sport keeps loading you the same way, and you can’t change that. Or don’t want to
• Flare-ups cost you something you care about — time off work, missed training, a cancelled trip
• You’re doing the active work, and the hands-on care is what lets you keep doing it. That’s the combination the evidence actually supports, and it’s the best reason to book there is

And when I won’t raise it: you came in with a single injury, we sorted it out, and you’re moving well and exercising regularly. Book me when you need me.

One patient who comes to mind, they work virtually from home at a desk during the day, and in the evenings are completing an online master’s program. With these life circumstances, they know how their next year looks, and how their neck and shoulder pain is affected from being in this position. So they keep a standing monthly appointment to deal with their expected symptoms. However, recently they have had a longer improvement between visits. They wanted to keep a recurring appointment, so we spaced it out to every 8 weeks. If they feel great at this next visit, then I would recommend visits as needed, while ultimately leaving the frequency to the patient’s preference.

Wherever you end up, a good plan can answer three questions: what is this for, when does it end, and what should I be able to do by then? If your chiropractor can answer those, you’re in good hands. And any clinician worth seeing will be glad you asked.

My goal has never been to keep you on the schedule. It’s to get you out of pain efficiently, teach you what your body responds to, and hand the maintenance back to you — because that’s where the research says the durable gains live. If you want more of my standing answers to questions like this, they’re in My Chiropractic Top 3s, and I’ve written elsewhere about what an adjustment actually does.

And if something flares up in a year? Come back. That’s what I’m here for.

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Book chiropractic care in Victoria at Acacia Westside. Dr. Rose McParland offers chiropractic care, shockwave therapy, and one-on-one Clinical Pilates.

References

1. Haas M, Vavrek D, Peterson D, Polissar N, Neradilek MB. Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. The Spine Journal. 2014;14(7):1106–1116.
2. Pasquier M, Daneau C, Marchand A-A, Lardon A, Descarreaux M. Spinal manipulation frequency and dosage effects on clinical and physiological outcomes: a scoping review. Chiropractic & Manual Therapies. 2019;27:23.
3. Axén I, Hestbaek L, Leboeuf-Yde C. Chiropractic maintenance care — what’s new? A systematic review of the literature. Chiropractic & Manual Therapies. 2019;27:63.
4. Eklund A, Jensen I, Lohela-Karlsson M, et al. 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;13(9):e0203029.
5. Eklund A, Jensen I, Leboeuf-Yde C, et al. The Nordic Maintenance Care Program: Does psychological profile modify the treatment effect of a preventive manual therapy intervention? A secondary analysis of a pragmatic randomized controlled trial. PLoS ONE. 2019;14(10):e0223349.
6. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444.
7. Kent P, Haines T, O’Sullivan P, et al. Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. The Lancet. 2023;401(10391):1866–1877.
8. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews. 2021;9:CD009790.
9. Rubinstein SM, de Zoete A, van Middelkoop M, et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689.