Osteopathic medicine is among the fastest-growing sectors of health care. By the year 2020, it is projected that approximately 100,000 doctors of osteopathic medicine will be practicing in the United States. Despite its growing popularity, osteopathic medicine is not as widely understood as traditional medicine, also known as allopathic medicine. Manipulation, a component of osteopathic medicine, is often a subject of debate, especially in today's age of evidence-based medicine. Questions are raised: What is the purpose of osteopathic manipulation? Who would benefit from it? What harm can come from the practice? This article answers these questions by discussing the philosophy of osteopathic medicine, delineating the differences between osteopathic physicians and other practitioners who perform manual medicine, and reviewing some of the current literature available. The article particularly focuses on the use of manipulation in the athletic setting. This is a subject that has not been investigated to any significant degree in the scientific literature, despite its widespread use.