Low back pain is a common and costly condition in industrialized nations. Consequently, a variety of treatment modalities and providers are available. A widely recognized clinical practice guideline states that spinal manipulation, as potentially provided by various types of practitioners, can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms. The underlying principles of osteopathic manipulative treatment (OMT) suggest the potential utility of OMT in both acute and chronic low back pain. The author summarizes the methodologic characteristics and results of the three major clinical trials of OMT for low back pain conducted in the United States and discusses their implications for osteopathic medicine.