Efficacy of spinal manipulation for low back pain has not been reliably shown.

EDITOR--In their editorial[1] Ernst and Assendelft refer to a review by Shekelle et al, which concludes that "spinal manipulation is of short-term benefit in some patients, particularly those with uncomplicated, acute lowback pain."[2] Ernst and Assendelft point out that this work did not contain a single trial of chiropractic. The references in the review by Shekelle et al do in fact include chiropractic trials.[2] The second reference listed is the trial by Meade et al.[3]

The second paragraph of the editorial refers to a review by Assendelft et al of eight randomised controlled trials of chiropractic treatment. This review concludes that the eight trials provide no …