• back pain
• osteoporosis
• spinal manipulation
• chiropractic

Sports medicine clinicians with varied training include joint mobilisation and manipulation among their therapeutic skills. Examples include chiropractors, physiotherapists, and osteopaths, not to mention the doctors and massage therapists who treat various joint pathologies. Although athletes rarely have osteoporosis, the broad field of sports medicine includes the use of exercise therapies and treatment of the musculoskeletal system in people of all ages. Therefore this leader focuses on the role of chiropractic joint manipulation.

Back pain sufferers from more than 60 countries consult chiropractors.¹ A booklet by the British Chiropractic Association boldly states that “95% of back pain is mechanical in origin, and can be treated by a chiropractor in a primary care setting”.² Yet there are many who doubt such promotional statements. A recent, perhaps more sober, assessment of the data reads differently: “43 randomised trials of spinal manipulation for treatment of acute, subacute and chronic low back pain have been published. 30 favoured manipulation over the comparison treatment in at least a subgroup of patients and the other 13 found no significant differences”.³ However, these trials used mostly non-chiropractic spinal manipulation. The only systematic review of exclusively chiropractic spinal manipulation concluded that “the available RCTs provided no convincing evidence of the effectiveness of chiropractic for acute or chronic low back pain”.⁴ Since the publication of this article, the emerging trial data have not tended to be encouraging. The effectiveness of chiropractic spinal manipulation for back pain is …