Back pain. New government-sponsored evidence-based national clinical guidelines for the management of back pain in the UK (CSAG 19941) and in the US ( AHCPR, 19942) have endorsed the traditional chiropractic approach to management by recommending spinal manipulation and early activity for most patients. The expert panels for these guidelines, predominantly medical experts, have also included chiropractors.

A summary of ACC guidelines for management options for an episode of acute low back pain based on the evidence available at present are:

• Advice to stay active and continue usual activities
• Paracetamol
• NSAID’s ( non-steroidal anti-inflammatory drugs )
• Manipulation - in the first 4-6 weeks

In 1979, a New Zealand Commission of Inquiry into Chiropractic, which investigated chiropractic education and practice in New Zealand, Australia, Canada, the UK and the US, had this to say:

“ The Commission has found it established beyond any reasonable degree of doubt that chiropractors have a more thorough training in spinal mechanics and spinal manual therapy than any other health professional. It would therefore by astonishing to contemplate that a chiropractor, in those areas of expertise, should be subject to directions of a medical practitioner who is largely ignorant of these matters simply because he has had no training in them. That is one reason why physiotherapists are becoming irritated by their present positional as paramedicals. They know more about physiotherapy than most doctors do, and they tend to resent uninformed medical direction. That is why chiropractors have been so diffident about accepting the “referral ethic”; in the field of spinal manipulation they are the experts; no doctor has the training or experience to tell them how to diagnose a vertebral malfunction or how to manipulate it.

The health team of the future will be one where all members of it take the trouble to understand, appreciate and, above all, respect each other’s special area of expertise. Each member will understand and appreciate his own limitations. There is no room for professional jealousy or arrogance, although we would hope that there would be room for professional pride in the overall standards of the team. And each member will be prepared to pool his expertise with that of the others for the benefit of the patient who is, after all, the basic reason for the health team’s existence.”