Spinal manipulative therapy (SMT) is widely used by chiropractors, osteopaths and physiotherapists, for musculoskeletal conditions, including neck pain. SMT has been shown to reduce neck pain in adults in general and in older people specifically. Furthermore, there have been small studies reporting positive effects of manual therapy in improving dizziness and musculoskeletal pain in older people. In fact, there is evidence that dizziness specifically associated with neck pain in adults may be attenuated with manual therapy, including SMT. However, previous studies have several important limitations including: lack of specific examination of neck pain; lack of a control group ; use of a ‘no treatment’ control group , issues with appropriate outcome measures and small sample sizes. SMT can be performed manually or assisted through an instrument. There is some evidence suggesting that low-force Activator™-instrument-assisted manipulation may produce effects on musculoskeletal pain that are comparable to those of manual SMT. Even though reported significant harms following neck SMT in older people are rare, due to increased risk of osteoporosis in this population, low-force SMT techniques are recommended by recent chiropractic guidelines