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Table 1 Recommendations of the Agency for Health Care Policy and Research on spinal manipulation for low back problems in adults*

From: Osteopathic research: elephants, enigmas, and evidence

Recommendation Rating Level of evidence
Manipulation can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms. B Moderate research-based evidence
When findings suggest progressive or severe neurologic deficits, an appropriate diagnostic assessment to rule out serious neurologic conditions is indicated before beginning manipulation therapy. D Panel interpretation of information that did not meet inclusion criteria as research-based evidence
There is insufficient evidence to recommend manipulation for patients with radiculopathy. C Limited research-based evidence
A trial of manipulation in patients without radiculopathy with symptoms longer than one month is probably safe, but efficacy is unproven. C Limited research-based evidence
If manipulation has not resulted in symptomatic improvement that allows increased function after one month of treatment, manipulation therapy should be stopped and the patient re-evaluated. D Panel interpretation of information that did not meet inclusion criteria as research-based evidence
  1. *Based on reference 6