The effectiveness of manual therapy in people with chronic non-specific low back pain: an umbrella review with meta-analysis

BACKGROUND: Chronic nonspecific low back pain (CNLBP) is a widely recognized condition worldwide. Its clinical management must be based on the best current evidence to achieve optimal outcomes, yet there is still a lack of consensus on its clinical approach. OBJECTIVE: To evaluate the effectiveness of manual therapy (MT) on pain intensity, frequency, disability, and quality of life in adults with chronic nonspecific low back pain (CNLBP). METHODS: A comprehensive search was conducted in 8 databases, covering January 2014 to October 2024. Inclusion criteria included adults with CNLBP, MT interventions provided by healthcare professionals, and systematic reviews (SRs) of randomized controlled trials (RCT). Data on pain intensity, pain frequency, disability, and quality of life measured using validated scales were extracted. The results were shown according to the type of intervention and the period evaluated (short, medium, or long term). RESULTS: About 21 SRs with 35,711 participants were included. MT included spinal manipulation, soft-tissue techniques, myofascial techniques, massage, and neuromeningeal techniques. MT outperforms other interventions regarding pain (MD -10.52; 95% CI -13.71 to -7.33) and disability (SMD -0.60; 95% CI-0.80 to -0.40) in the short term, and this effect diminishes over time. CONCLUSIONS: MT offers significant short-term benefits in reducing pain and disability in individuals with CNLBP. Like most interventions for CNLBP, the effects of MT tend to diminish over time. Nevertheless, MT may serve as a valuable treatment option for short-term pain relief and functional improvement. Limitations in the methodological quality and long-term follow-up of included studies constrain the conclusions that can be drawn about long-term efficacy. REGISTRATION: PROSPERO, CRD42023382825.