PURPOSE: Manual techniques, including joint manipulation and joint mobilization, are frequently used in the treatment of low back pain. Clinical studies establishing the efficacy of these manual techniques must include operational definitions that clearly outline their method of application. This review of the literature examines whether or not clinical studies make an adequate distinction between manipulation and mobilization when establishing the efficacy of these manual techniques in the treatment of lumbar spine disorders. METHODS: A literature search was conducted for the period 1986 to 2000. All clinical studies selected had to be randomized clinical trials concerned with the efficacy of manipulation and/or mobilization of the lumbar spine. RESULTS: Fifteen clinical studies were reviewed. Only one study adequately defined manipulation. The remaining 14 studies provided no definitions, or inadequate definitions of manipulation and mobilization. Four of these 11 studies also incorrectly classified themselves as "controlled" studies. CONCLUSION AND DISCUSSION: The literature does not adequately distinguish between mobilization and manipulation when establishing the efficacy of these manual techniques. Caution is required when referring to the literature regarding the efficacy of manipulation and mobilization techniques. Future studies in this area need to be well-designed and provide definitions of the manual techniques under investigation. Since evidence-based practice is growing, it is important for clinical and non-clinical personnel to have a knowledge of how to interpret the literature regarding these techniques.

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