[Conservative therapy of backache. Part 4: Manual therapy]

The literature on the clinical effectiveness of manipulation in low back pain is extensive, although scientific studies that are free from flaws are much rarer. Most of the studies so far done show--with some reservations--a positive effect for manipulation. Given the proper indication, and with care being taken to observe contraindications, this modality can thus be recommended if performed by an experienced manipulator. However, this should not blind us to the fact that further investigations are necessary, and that the technique has no unequivocal advantages over exercise.