Although approximately 200 treatment options are available to treat low back pain,1 no single treatment is clearly superior. Furthermore, the etiology of back pain is often unclear, possibly contributing to treatment strategies for low back pain often being determined by preferences of the clinical care practitioner.
Spinal manipulative therapy (SMT) is a controversial treatment option for low back pain, perhaps in part because it is most frequently administered by chiropractors. Chiropractic therapy is not widely accepted by some traditional health care practitioners. This may be, at least in part, because some early practitioners of chiropractic care rejected the germ theory, immunizations, and other scientific advances.