Chronic low back pain causes immense disability and costs to society. Many interventions are used to manage chronic low back pain, such as exercise, pain education and spinal manipulation. The benefits of spinal manipulation include reductions in pain and disability. However, as the site of pain is usually very sensitive, there is still debate about the need for specific manipulation (i.e., at the site of the painful vertebral segment).

A recent randomised trial conducted by a collaboration of academic and clinical physiotherapists sought to determine the average effect of directing manipulation at the most painful lumbar level compared with generic manipulation of the spine.