Back pain is one of the most common health complaints, affecting 8 out of 10 people at some point during their lives. The lower back (the lumbar spine) is the area most often affected. For many people, back pain goes away on its own after a few days or weeks but for others, the pain becomes chronic and lasts for months or years. Low-back pain (also referred to as low back pain, LBP, or lumbago) can be debilitating, and is a challenging condition to diagnose, treat, and study. The total annual cost of low-back pain in the United States, including lost wages and reduced productivity is more than $100 billion. Spinal manipulation, sometimes called “spinal manipulative therapy” is practiced by health care professionals such as physical therapists but can also be provided by chiropractors, osteopathic physicians, naturopathic physicians, and some medical doctors. Manipulations can be an effective adjunct to compliment other treatments including stretching and strength training exercise, massage, and joint mobilization. The amount of force applied with manipulative thrusts depends on the form of manipulation used. The goal of the treatment is to relieve pain and improve physical functioning (the ability to walk and move). Reviews of research studies have concluded that spinal manipulation for low-back pain is safe when performed by a trained and licensed practitioner. The most common side effects (e.g., discomfort in the treated area) are minor and short lived. Serious complications are very rare. Cauda equina syndrome (CES), a significant narrowing of the lower part of the spinal canal in which nerves become pinched and may cause pain, weakness, loss of feeling in one or both legs, and bowel or bladder problems may be an extremely rare complication of spinal manipulation. Tell all your health care providers about any complementary health treatments you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.