FEBRUARY 2013: A comprehensive review has concluded that spinal manipulative therapy (SMT) is no more effective for acute low back pain than inert interventions, sham SMT, or as adjunct therapy, and also seems to be no better than other recommended therapies. The reviewers looked at 20 randomised controlled trials with a total of 2,674 participants. The studies varied greatly in quality and contained very little data on recovery, return-to-work, quality of life, and costs of care. [Rubinstein SM and others. Spinal manipulative therapy for acute low back pain: An update of the Cochrane Review. Spine 38:E158-E177, February 2013]  The situation faced by consumers who consult chiropractors is actually much worse than published studies indicate. In the most important studies, patients are appropriately screened for contraindications - often by medical teams - and the treatment is limited by the experimental protocol. However, in the real world, the odds of getting appropriate treatment are much lower because fraud, overtreatment (including "adjustments" to correct "subluxations"), and a wide variety of other unscientific practices are rampant in chiropractic offices.