Manual Therapy

Below is a summary of the key recommendations regarding the use of manual therapy as a treatment for LBP:

  • Currently, there is no convincing evidence that spinal manipulative therapy (SMT) has superior clinically important benefits to sham SMT for the treatment of CLBP [1].
  • Manual therapy should be used in conjunction with exercise therapy, pain education and where indicated, pyschological therapy [2, 3].
  • The type of manual therapy should be based on the clinician’s experience, patient’s preferences and best available evidence.


  1. Rubinstein SM, de Zoete A, van Middelkoop M, et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019;364:l689
  2. Bernstein, I. A., Malik, Q., Carville, S., & Ward, S. (2017). Low back pain and sciatica: summary of NICE guidance. BMJ, 356, i6748
  3. Oliveira, C. B., Maher, C. G., Pinto, R. Z., Traeger, A. C., Lin, C.-W. C., Chenot, J.-F., . . . Koes, B. W. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal. doi:10.1007/s00586-018-5673-2