Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine.[19][59] Chiropractic is autonomous from and competitive with mainstream medicine,[60] and osteopathy outside the US remains primarily a manual medical system;[61] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[60] Practitioners may distinguish these competing approaches through claims that, compared to other therapists, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.[19]
A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of spinal manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[161] A 2005 American systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention.[162] The cost-effectiveness of maintenance chiropractic care is unknown.[12]
Finally, it’s important to know that it’s okay to change chiropractors if the doctor you find just isn’t a good fit. They may be perfectly qualified and capable, but if you aren’t comfortable with them, treatment may be less effective. Some patients love doctors who are straight and to the point, while others prefer someone who provides lots of explanation both before and during a procedure. Likewise, they may not be the best doctor to treat your specific pain condition. As with other doctors, chiropractors understand this and are happy to transfer your records to a different doctor.
All treatment is based on an accurate diagnosis of your back pain. The chiropractor should be well informed regarding your medical history, including ongoing medical conditions, current medications, traumatic/surgical history, and lifestyle factors. Although rare, there have been cases in which treatment worsened a herniated or slipped disc, or neck manipulation resulted spinal cord injury. To be safe, always check with your medical doctor to make sure your condition will benefit from chiropractic or other pain relief alternatives. 
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