Who needs maintenance?

08 Apr Who needs maintenance?

In this month’s Blog, practice owner, and osteopath for 20+ years, Graeme Rider discusses a topic that regularly comes up in the clinic:

Is the concept of maintenance treatment for those in pain unethical?

It’s interesting to consider the potential value of ‘maintenance’ in today’s world.

Well firstly, what does it mean? I guess it is the idea of minimising dysfunction, as well as maximising performance, by regularly checking and if necessary, addressing all relevant individual components.

It seems the acceptance of the idea varies greatly between industries. How many of us have our boiler serviced on an annual basis, compared to say, our cars? Why is one easier to sell than another?

For most of us, the most obvious concern is that it is simply a cunning plan by a manufacturer to squeeze more money from us. I for one, detest being offered a warranty on a new purchase. Isn’t it an admittance of impending failure?

So, what does maintenance look like within medicine?

The Dental profession have created a very thorough package; teeth being cleaned twice per day, regular flossing, and check-ups every six months.

Ophthalmology is another interesting example. You’re prescribed glasses, often to compensate for eye musculature that weakens as we get older. These muscles are then able to work less hard. Unsurprisingly, when your vision is checked two years later, the musculature has weakened further, resulting in a stronger prescription. It is self-perpetuating.

The question is, within musculoskeletal medicine, are Osteopaths, Physios, Sports Massage Therapists, and Acupuncturists part of the problem or part of the cure?

The boiler and car examples I mentioned can be a bit misleading. Whilst the body and its various functions are what I term ‘fluid’, the boiler or car functions are mostly ‘non-fluid’. By that I mean the manufactured component either works or it doesn’t. In contrast, a heavily osteoarthritic knee works, but only to a certain sub-optimal level of performance.

Since the day we were born, there has been this trade-off between function and injury. No matter how much effort the practitioner and the patient make, injuries seldom fully heal. We are all products of every musculoskeletal incident we have endured during our lives. That rugby tackle at 15, the car crash at 38 etc, it all creates a picture.

The argument for maintenance

I have absolutely no problem arguing in favour of maintenance approaches within MSK medicine, but only under the right circumstances.

As practitioners, sometimes I feel we are not overly clear in explaining to patients why we spend a good deal of treatment time addressing areas away from the actual site of injury. If we were to start by explaining that a lower back injury has left the area stiff or weak and therefore part of our goal is not only to support it but to help take some of the workload off it by improving the function of areas above and below the site of injury, I’m sure that would improve patient understanding of the potential value of a maintenance-type approach.

I suspect there is also a psychological benefit associated with maintenance. There can be an over-reliance on a practitioner to provide a magic cure during those 40-odd minutes of treatment. An admission that this injury isn’t simply going away and therefore requires an ongoing approach can only encourage patient self-responsibility. A good thing.

Are maintenance treatments for everybody?

However, I would estimate that between 30-40% of all my patients benefit from regular intervention. That might vary from once a month to once a year, but I am totally confident that it significantly improves function (ie the ability to do more), as well as greatly reducing both the frequency and intensity of acute episodes or flare-ups.

Toby Pollard-Smith

Toby is an osteopath at OpenHealth, and regularly contributes to our blogs.