Adding manual therapy to back exercises improved disability, while pain results were uncertain
The review found different results for pain and functioning in adults with persistent nonspecific low back pain.
Based on the published abstract. The full paper may contain additional methods, results and limitations.
The 30-second takeaway
Adding joint mobilization or manipulation to exercise did not produce a statistically significant extra reduction in short-term pain. Combined treatment did improve functional disability at shorter and longer follow-up. Confidence in the evidence ranged from moderate to low, leaving uncertainty about the size and reliability of the additional benefits.
This abstract-based summary cannot assess exact follow-up times or absolute changes. Pain results varied substantially across studies, and that evidence was rated low quality.
What researchers found
Short-term pain intensity
Manual therapy plus exercise versus exercise alone; standardized mean difference scales the gap to the spread of pain scores, rather than pain-scale points. Negative values favor combined treatment. The interval includes no difference; this result was not statistically significant.
Pain and function differed
Disability results favored combined therapy, while the pain estimate remained uncertain. These are separate outcomes. A nonsignificant pain result does not establish that the treatments are equivalent.
What treatment involved
Manual treatments involved spinal mobilization, manipulation or both. Exercise included stretching, strengthening, movement control and endurance work. The abstract does not identify which combination accounted for disability improvements.
The original publication
Effectiveness of adding manual therapy to exercise for pain and disability in chronic non-specific low back pain: A systematic review and meta-analysis.
Dos Santos ECS, Dos Santos AT, da Silva NA et al.
Musculoskelet Sci Pract · 2026
- PubMed ID
- 41643247
- Record checked
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