The human spine, particularly its lowest 5 segments, has come in for a lot of criticism; but we should not forget that it also provides a living for millions of people such as osteopaths, chiropractors, acupuncturists, reflexologists, plus manufacturers of orthopaedic beds, TENS machines, and other purveyors of “guaranteed relief.” For most doctors, however, back pain is just a pain. Patients come to us expecting a diagnosis and some rational treatment, but with chronic back pain, all we can do is share their frustration and learn a bit of humility. In the UK, physiotherapy (physical therapy) has always been incorporated into the NHS whereas manipulative therapies have not. A British cost utility analysis (