Jump up ^ Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA (2011). "Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review". J Physiother. 57 (1): 11–20. doi:10.1016/S1836-9553(11)70002-9. PMID 21402325.
Chiropractors often argue that this education is as good as or better than medical physicians', but most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing.[65] The fourth year of chiropractic education persistently showed the highest stress levels.[188] Every student, irrespective of year, experienced different ranges of stress when studying.[188] The chiropractic leaders and colleges have had internal struggles.[189] Rather than cooperation, there has been infighting between different factions.[189] A number of actions were posturing due to the confidential nature of the chiropractic colleges in an attempt to enroll students.[189][clarification needed]
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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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