Spinal manipulation effective for low back pain

Spinal manipulation, usual care with analgesics, physical therapy, exercises, and "back school" all provide similar results when used for treatment of both acute and chronic low back pain. Clinicians may wish to treat patients with low back pain themselves or refer them for chiropractic care, physical therapy, or back schools. This decision should be based on patient preferences after reviewing relative risks and benefits. A recent systematic review of alternative therapies for low back pain reported similar effects from spinal manipulation and massage therapy. The effectiveness of acupuncture in the management of low back pain remains unclear