Low back pain affects almost a third of Americans. While there is a long-standing belief that low back pain is limited to adults, research has shown it develops with increasing frequency during adolescence. With the increasing concern about opioid prescription rates, including among U.S. youth—up to 40 percent with low back pain receive opioids as part of their treatment—there is heightened urgency to identify safe and effective non-drug treatment options. Spinal manipulation and exercise are two such approaches which are recommended for adults with low back pain. Little is known, however, regarding the effectiveness of these treatments for adolescent low back pain sufferers.