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Low back pain: comparison of chiropractic and hospital outpatient treatment

therapists.2 The contrast between a strongly positive approach on the one hand and a relatively negative one on the other might well have influenced the longterm results. Chiropractic was not universally superior in the patients studied. Why does it not work in patients without a previous history of back pain? Why did one of the 11 hospital centres achieve marginally better results than chiropractic? Could it have been that this centre, which operated an open access policy, had physiotherapists with particular skills in managing back pain? It is premature to moot chiropractic on the NHS. Rather, this excellent study highlights the need for good quality research on manipulation. Meanwhile, there should be better hospital facilities, more encouragement for physiotherapists to train in manipulative techniques, and, perhaps, a bolder and more optimistic approach from physiotherapists currently treating back pain.