Low back pain presents a major challenge to health care professionals within both primary and secondary care. Spinal manipulation therapy is one option from a range of treatment techniques which until recently has lacked credibility, in part due to a dearth of published, plausible explanations of the mechanisms through which it works. Such explanations are starting to emerge but rigorous evaluations of spinal manipulation therapy over other treatment modalities remain few in number. This paper builds on the review by Mohseni-Bandpei et al (Mohseni-Bandpei MA, Stephenson R, Richardson B. Spinal manipulation in the treatment of low back pain: a review of the literature with particular emphasis on randomised controlled trials. Phys Ther Rev 1998;3:185-194), by reviewing literature in particular randomised controlled trials published in the field since that date. It is concluded that the efficacy of manipulation for patients with acute or chronic low back pain remains unconvincing and that the literature remains blighted by inconsistency of definitions of interventions and by methodological flaws.

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