How Many Visits is Most Effective for Patients With Low Back Pain?

Very little is known about the optimum number of chiropractic visits required to be most effective for patients suffering from chronic low back pain. This is in part because of the large number of potential diagnoses, variations in symptom severity, and many co-occurring factors that can influence prognosis. A group of researchers from Western States University examined this question from a dosing perspective by comparing spinal manipulation therapy (SMT) with a light massage control.

Enrolling 400 participants, investigators randomly assigned participants into four groups. All participants scheduled 18 sessions of care (three visits per week) but received four different “dose levels” of SMT (0, 6, 12, and 18) based on their group assignment. Changes in pain intensity and functional disability were measured at 12 and 24 weeks after enrolling in the study. Other outcomes included days with perceived pain and function disability, pain unpleasantness, global perceived improvement, nonprescription medication use, and general health status. What did the data show?

  • 12 sessions of SMT yielded the most favorable pain reduction and functional improvement of the 4 dose levels
  • Participant improvement following 12 sessions was sustainable after 52 weeks

Take-Home Message

Participants receiving 12 sessions of SMT over a six-week period had less pain and disability after 12 weeks compared with those receiving 0, 6, or 18 sessions.

Practical Application

This is the only study to date that specifically evaluates “dosing” of chiropractic care for patients with low back pain. This study lays a foundation for future research in this arena. Answering questions related to finding the most effective dose for patients with specific conditions has far reaching health policy implications for providers, patients, and payers.

For more information, the complete article is online at:


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. Spine J. 2014;14(7):1106-16.