Commentary: we can tell where it hurts, but can we tell where the pain is coming from or where we should manipulate?

The shared decision making process has become increasingly important in the management of spinal disorders where there remains a variety of treatment options. Spinal manipulative therapy (SMT) is often recommended as a conservative option by evidence based clinical practice guidelines and a treatment modality frequently utilized by chiropractors and other clinicians who offer SMT to their patients. This article serves as a commentary to a review of the methods that are often used by chiropractors to determine the site for applying their manipulative intervention. Though it may be easy to criticize any review of this type of literature and point out shortcomings there are strong take away messages for the clinician interested in employing SMT as a part of their treatment protocol. Most notably, clinicians can be reassured that a history on the localization of pain, tissue palpation, provocative testing, range of motion testing and the demonstration by the patient of the locus and description of pain have reasonable consistency between observers. What this paper does not inform us on is the nature of the lesion causing the pain or where the manipulation should be applied to obtain the best outcome.