Spinal manipulation in the treatment of low back pain: a review of the literature with particular emphasis on randomized controlled clinical trials

Low back pain is one of the most common causes of disability and working days lost, particularly in industrialized countries, with a high lifetime prevalence and annual incidence. There is adequate evidence that physical therapy is widely used in the treatment of low back pain, and spinal manipulation therapy is a common therapeutic procedure employed for such patients. Although there has been considerable growth in the use of manipulation, there is still no clear information of the mechanism by which manipulation relieves low back pain. The efficacy of manipulation for patients with acute or chronic low back pain has not been convincingly demonstrated through literature. Based on this review of the literature (1985–1997), manipulation has been found to be more effective than other referenced treatments.