This study evaluates the effect of standard of care treatments (physical therapy versus manual therapy) in older adult patients who have balance problems with or without low back pain.

This study uses a randomized controlled research design and will enroll up to three hundred patients. Treatment will take place in outpatient facilities. It is hypothesized that among older adults with low back pain manual therapy will reduce low back pain and improve balance more than physical therapy; and that among older adults without low back pain manual therapy and physical therapy will be equally efficacious in improving balance. The results of this study will help to further define effective treatment protocols.

Inclusion Criteria:

• Between ages 60-85
• self reported balance problems
• With or with out low back pain.

Exclusion Criteria:

• History of recent fracture or surgery of lumbar spine, pelvis, hip or femur
• History of recent neoplasm (minor skin cancers are not excluded)
• Acute infectious disease
• Chronic low back pain persisting for >8 weeks
• Severe disabling health problems so that patient is not ambulatory
• Non-mechanical low back pain
• Recent unstable peripheral vascular disease and or cardiac disease requiring recent hospitalization < 6 months ago
• Patients with balance problems related to the following: Meniere's disease, vertigo, or vestibular disorders
• Recent history of self reported substance abuse
• Ongoing treatment for balance problems or low back pain by chiropractor, physical therapist, or orthopedic physician or other physician.
• Current use of medication from the following categories: antipsychotics, anxiolytics, and sedative/hypnotics