Back-pain review finds no clear overall winner between exercise and manual therapy
In adults with chronic low back pain, exercise had a small long-term disability advantage over hands-on therapy. The authors judged it clinically unimportant, with very low certainty across outcomes.
Based on the published abstract. The full paper may contain additional methods, results and limitations.
The 30-second takeaway
For adults with chronic low back pain, exercise therapy showed a statistically significant long-term advantage over manual therapy for disability. However, the authors judged that difference too small to be clinically relevant. Evidence certainty was very low, and the review did not establish an overall advantage sufficient to choose either approach as a stand-alone treatment.
Only a limited set of trials was included, results varied between studies, and certainty was rated very low for every outcome. The abstract does not specify the timing represented by long-term follow-up.
What researchers found
Disability compared with manual therapy
At long-term follow-up, standardized mean difference = -0.25 (95% CI -0.43 to -0.07), a difference on a shared statistical scale. The authors judged it clinically unimportant.
Statistical and practical importance differ
A statistically significant score difference can still be too small to matter clinically. That distinction is explicit here: the pooled disability result favored exercise, while the authors described the difference as not clinically relevant.
Why an overall ranking remains uncertain
The review also examined pain intensity and physical function, but its conclusions did not establish clear overall differences between treatments. Study variation and very low evidence certainty limit confidence in extending the disability finding to a general treatment ranking.
The original publication
Exercise Therapy Versus Manual Therapy for the Management of Pain Intensity, Disability, and Physical Function in People With Chronic Low Back Pain: A Systematic Review With Meta-Analysis and Meta-Regression.
González-Gómez L, Moral-Munoz JA, Rosales-Tristancho A et al.
Eur J Pain · 2025
- PubMed ID
- 40747709
- Record checked
AI-assisted research and writing. This explains one selected publication; it is not a complete review of everything known. Our approach.
One more question, understood.
Keep track of the research you’ve explored.