[Common low back pain and vertebral manipulations. Inventory. Evaluation, presumptive mechanisms of action. Problems]

Published data on the efficacy and presumptive modes of action of spinal manipulations are reviewed, as well as current problems with the technique. Although the best-designed studies have shown promising results, the efficacy of spinal manipulations has not as yet been firmly proven. The mode of action may involve mechanical changes in the disk and facet joints, but neurological mechanisms probably play the key role. Complications of cervical spinal manipulations are rare. To protect patients, French law requires that spinal manipulations be performed only by licensed physicians, who are the only professionals capable of establishing the accurate diagnosis before undertaking manipulations.