Manipulative therapies include osteopathic manipulative treatment and many other forms of manual therapies used to manage a variety of conditions in adults and children. Spinal manipulative therapy may provide short-term improvement in patients with acute or chronic low back pain, comparable with other standard treatments. When compared with oral analgesics, cervical manipulation and/or mobilization appears to provide better short-term pain relief and improved function in patients with neck pain. Manipulative therapies may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intensity of pain. Although manipulative therapy is sometimes recommended to treat conditions in children (e.g., musculoskeletal problems, otitis media, respiratory conditions, infantile colic, allergies), there is supporting evidence only for reducing the length of hospital stay for preterm infants. Mild adverse events, such as muscle stiffness and soreness, occur in up to 50% of adults who undergo manipulative therapy. Although serious adverse events such as lumbar disk herniation, cauda equina syndrome, and vertebrobasilar injury are rare, they can cause significant disability or death. Given the limited proven benefits of manipulative therapies and small risk of serious adverse events, additional high-quality, adequately powered studies are needed before definitive recommendations can be made for treating many conditions.