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Low back pain (LBP) can interfere with an individual’s ability to work, have a meaningful and active social life, and negatively affects overall quality of life. In recent years, new approaches have been considered as alternative treatments for LBP. Spinal manipulative therapy (SMT) is one of these new approaches to acute LBP treatment. Still, recent studies have found contradicting results in terms of the effectiveness of such alternative therapies. This study aimed to compare the effect of SMT in combination with standard physical therapy (SPT) versus SPT alone to treat chronic LBP. A randomized, controlled, parallel-group trial was undertaken in the Worker’s Compensation System, in Puerto Rico. A total of 66 subjects were enrolled in the study. The intervention consisted of adding two consecutive SMT two days apart followed by SPT for a total period of one month. The main outcome measures were functional impairment in activities of daily living, disability and perceived level of pain intensity and frequency. Results showed that both interventions were moderately effective in managing pain and disability in patients with chronic LBP who participate in the Worker’