Shekelle and colleagues [1] under-represented the important contributions to spinal manipulation by the osteopathic medical profession. There are many osteopaths in the United States who use osteopathic manipulative treatment effectively in both the inpatient and outpatient settings. The data and methods in the review were heavily biased in favor of chiropractic care, omitting many important publications by and including osteopathic physicians [2-5]. Ironically, Andrew Taylor Still, MD, the founder of osteopathic medicine, discovered osteopathic manipulation and its holistic medical approach almost 20 years (1874) before chiropractic was discovered (1895), and D. D. Palmer, the founder of chiropractic, was one of his pupils.

Shekelle and coworkers' article [1] did not mention any osteopathic physicians included among the "specialists." According to their Methods section, Index Medicus and MEDLINE searches did not use the MeSH terms "osteopathic" or "osteopathic manipulation." Using my affiliated hospital's library, I did a MEDLINE search from 1966 to the present, and, after evaluating the bibliographies, I retrieved at least 65 articles and pieces of correspondence that were relevant to the topic of spinal manipulation from an osteopathic, allopathic, and chiropractic perspective.

Osteopaths who are experienced in the area of chronic low-back pain use accepted medical regimens that include appropriate pharmacologic agents, physical therapy, ice and heat, rest, and gradual exercise and stretching to improve mobility. They combine this with injection therapy, spray and stretch mobilization, and specific types of soft-tissue, myofascial, and high-velocity, low-amplitude osteopathic manipulative adjustments and techniques. Using spinal manipulation in such a well rounded and carefully orchestrated manner can be an asset even to MDs.

Although spinal manipulation is controversial, given the popularity of both the chiropractic and osteopathic professions over the last century, perhaps a joint collaboration among osteopaths and chiropractors would be of great benefit to the medical and lay public.