My Recommendations, Reasons and Research Support for Wellness Care Adjustments 

 October 11, 2018

By  Dr. Tripp Stover, D.C.

If you are at the end of a restorative care plan the best thing you can do is continue with wellness care.  In short, it prevents new subluxations, allows for continued restorative changes that can take up to a year to manifest, decreases future flare ups, and helps you do what you like to do.

How do we know this?  Apart from hearing the benefits from practice members over the past 20 years, there is quite a bit of good science, research, and support for maintaining spinal integrity with adjustments – at a rate of once every 2 to 4 weeks.  Here are some highlights from peer reviewed research, surveys, and case studies. *

Here is what we know:

  1. Every two weeks is the most effective, and healthy frequency for wellness care.
  2. We know that neural atrophy and joint degeneration happens in as little as a week’s time due to decreased joint movement. Subluxations limit movement and cause nerve irritation.
  3. We know irreversible changes occur in as little as 4 weeks.
  4. We know adjustments retard the progression of adhesion formation, joint arthritis, neuronal atrophy, and changes in muscle strength (including coordination).
  5. We know a 2004 study showed that adjustments in 3 week intervals maintained initial clinical improvement over 9 months.
  6. Presence or absence of pain does not correlate with need of, or frequency of adjustments.

Dr. Stover’s recommendation:  These are helpful guidelines.  Not everyone fits neatly into each of these categories.  Please, most importantly, consider wellness care at some level.  If your choice is to move forward with it, it needs to be your goals and life circumstances that dictate how you take advantage of wellness care.

General HealthBone HealthCurves After CarePosture After Restorative CareDiscFrequency of Wellness
Healthy SpineNo degenerationGood spinal curves


Good postureHealthy1/30 days
Phase 1Mild degenerationOutside of normal rangePosture pic shows moderate progressThinningEvery 3 weeks


Phase 2 or 3, prior or future spinal surgeryModerate to severe degenerationSignificant loss or increaseMinor positive postural changesThin or absentEvery 2 weeks


-In animal studies, fixation of facet (spinal joints) joints for 4-8 weeks causes degenerative changes and osteophyte formation of the articular surfaces….Sadly, facet articular surface degeneration began at less than 1 week.

-facet (joint) articular surface degeneration began at less than 1 week. The “common clinical treatment frequency at every 4 weeks correlates with the findings of the threshold of 4 weeks for irreversible degenerative osteophyte formation.” ”This finding correlates with the common practice pattern of progressive decreasing of the frequency of manipulation as the patient’s progress in recovery from an acute incident. It also indicates that even when patients present for once per month asymptomatic preventive manipulation, the process of degeneration of the articular surfaces may have already begun.”

-Facet joint fixation also resulted in synovial fold fibrotic adhesions that “progressed to mild adhesions in 4 weeks, moderate adhesions in 8 weeks, and severe adhesions after 12 weeks.”  

-Four weeks of joint immobilization has been found to cause a time dependent loss of neurons that becomes progressively worse thereafter. An increase in neurons occurs after release of the fixation.

-Such immobilization also causes time dependent muscle weakness, atrophy and fatty deposition of the multifidi muscles. The time-dependent factor progressed from normal muscles to mild, moderate, and severe muscular atrophy.

-Evidence “clearly demonstrates that the clinical consensus of dosage of maintenance manipulative therapy has been found to be most beneficial at an average of once every 2 to 4 weeks. We also see here that it closely correlates with the studies that show onset of facet joint degeneration, neural degeneration, neuroplastic changes, and muscular atrophy and weakness at an average of 2 to 4 weeks.”

-A 2004 chiropractic study of chronic low back pain showed that the group of patients who received 9 months of maintenance manipulation at the frequency of once per every 3 weeks maintained their initial clinical improvement while the control group returned to their previous levels of disability. The authors “concluded that there were positive effects of preventive maintenance chiropractic spinal manipulation in maintaining functional capacities and reducing the number and intensity of pain episodes after the acute phase of treatment of low back pain patients.”

-“There is a common thread of the time dependency noted in all the laboratory and clinical studies. The periods of onset of the anatomical and physiological changes ranged from 2 to 4 weeks. The clinical studies also provided MMT every 4 weeks and noted positive changes in the pain and disability measures. This time interval also correlates with the common recommendations found in the surveys of chiropractic physicians.” *


*  Here are a few good references to support the effectiveness of wellness care

“A Theoretical Basis for Maintenance Spinal Manipulative Therapy for the Chiropractic Profession”  By, David N Taylor DC, DABCN  Journal of Chiropractic Humanities, 7/5/2011

“Health Maintenance Care in Work Related Low Back Pain and Its Association With Disability Recurrence” Journal of Occupational and Environmental Medicine, 3/14/2011; vol 197  (chiropractic vs medical vs physical therapy maintenance effectiveness)

“Does Maintenance Spinal Manipulation Therapy for Chiropractic Nonspecific Low Back Pain Result in Better Long-Term Outcome?” Spine, 8/15/2011; vol 36, number 18, pp. 1427-1437

“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”  Public Library of Science 9/12/18 vol 13; No. 9; 68 references

Dr. Tripp Stover, D.C.

Dr. Stover grew up in Richmond. He has been married to his wife Andrea since 2000 and they make their home in Mechanicsville with their children, Avery and Garnett.

Dr. Tripp Stover, D.C.

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