One question I’m often asked is, “How many treatments will I need to get better?” While a figure of between 4 and 6 treatments is often stated, everyone is different, so the actual number you will need depends on various factors.
The first factor is how long you’ve had your problem. More chronic problems, which have been going on for a while, will often require more treatment to be properly sorted out.
The next factor is the complexity of your problem. Back pain can often result from many different issues interacting with each other. The real cause of your pain may not be in the back at all, but rather a result of problems elsewhere. The more factors identified and needing to be addressed, the more likely you’ll need more than the 4-6 treatments.
What you want from your treatment also matters. If you’re relatively sedentary and just want to get about without any pain, you’ll require less treatment than if you aim to be very active and participate in sports. Such activities create more load on your back, so it needs to work much better to handle this.
The final factor is your definition of ‘better’. Osteopathic treatment is usually highly effective at getting you out of pain. If you’re not experiencing some pain relief within 4-6 treatments, it would be unusual. In such a case, your condition would certainly need re-evaluating.
But does the absence of pain mean that you’re really better? There’s a big difference between pain relief and being better. Pain relief doesn’t account for whether your back is functioning well, and it’s usually only short-term and prone to recurrence as the risk factors haven’t been properly addressed. Being ‘better’ ensures proper function is restored to your spine, enabling your back to be more resilient and robust. This helps you deal with increased physical stress and strain to reduce the risk of recurrent problems.
Managing back pain can be likened to managing a bank account. Once you’ve paid off your overdraft, you’re no longer in pain. But without any savings, if you return to bad habits that contributed to your pain in the first place, without improving how your back functions and managing the risk factors, you’ll suffer a recurrence of your back pain.
The recurrence rate of back pain is very high. A recent 2019 study reported that within a year, 69% of patients had a relapse in their back pain, and over 40% of these had limited activity and required further treatment.
Patients often come in for a few treatments to get out of pain, then stop treatment until the next occurrence. Over time, if these patients don’t change their thinking about their back pain and work to improve their spinal function and manage the risk factors properly, their condition often worsens, occurring more frequently, lasting longer, and responding less to treatment.
One of my biggest frustrations in over 30 years of practice is seeing patients cease their treatment as soon as their pain subsides. It’s heartbreaking to know that they are probably on borrowed time until their next painful episode.
Interestingly, this issue isn’t unique to the osteopathic profession. Studies state that for chronic medical conditions requiring medication, about 50% of patients do not take their medication as prescribed. The reasons are likely varied and complex, but generally, they do not fare as well as those who stick to their prescribed treatment plan.
When contemplating treatment and the number of treatments you need, it’s essential to focus on the desired outcome, not just the relief of pain. Your osteopath should discuss this with you and provide a treatment plan, which should give you a good idea of how many treatments you will need to reach your goal. This plan can often be broken down into an estimated number and frequency of treatments to get you out of pain, then, following a review, the number and frequency of treatments to ensure that your back is working well, you are fully rehabilitated, and the risks of recurrence have been properly addressed. Even though this may feel unnecessary at the time as your pain has gone, it is the best insurance you have to not suffer further and potentially debilitating back pain.
Prevention really is better than cure, and in the long term, it usually works out to be cheaper too!
Steve Morris is an Osteopath with over 30 years’ experience. He is a specialist in the field of non-surgical treatment of disc conditions, especially sciatica. He uses various different treatment mediums, from hands on osteopathy and acupuncture to the use of mechanical decompression with IDD Therapy, for which he is one of the country’s leading exponents and experts.
