Manual Therapy for Recent-Onset or Persistent Non-Specific Lower Back Pain: A Review of Clinical Effectiveness and Guidelines

Key Message

The effectiveness of manual therapy for acute or chronic low back pain remains unclear due to variation in findings, significant clinical heterogeneity, and overall low methodological quality of the identified studies. There is some evidence to suggest that spinal manipulation and soft tissue therapy have positive effects on pain and function for acute and chronic low back pain; however, this evidence was of limited quality and results should be interpreted with caution. There is insufficient evidence on the effectiveness of spinal mobilization as it was often included as an adjunct to treatment with spinal manipulation. Evidence from one systematic review does not support the use of traction for low back pain with or without radiculopathy. No serious harms were reported in any of the included systematic reviews, suggesting manual therapy is a safe form of treatment. No evidence for the clinical effectiveness of manual therapy in pediatric patients was identified. Three evidence-based guidelines were identified that provided recommendations supporting the use of manual therapies for acute and chronic low back pain in adults. All three guidelines included a recommendation for the use of spinal manipulation. One guideline recommended against the use of traction. No evidence-based guidelines were identified providing recommendations on the management of acute or chronic low back pain in the pediatric population.