The efficacy of manual therapy and exercise for different stages of non specific low back pain

The non specific back pain is multidimensional which requires a bio-psycho-social framework. A lot of physical therapies and non pharmacological approaches become popular and the research in the field is growing each day. Research has shown that manual therapy is considered more effective than placebo treatment especially in terms of pain and function. A systematic review of manual therapy with a literature search covering April 2013 to February 2018 was conducted by two independent reviewers according to Cochrane and PRISMA guidelines. A research equation was implemented, in advanced research, in five databases in order to ensure a comprehensive literature search. 703 randomized controlled studies were identified through databases and 10 of them were selected and fully described in the results section. The heterogeneity of the studies prevents us to make relevant conclusion on the intervention provided. However, the different forms of manual therapy combined or not with exercise and education showed encouraging results in term of pain relief and functional restoration at short term for all stages of low back pain. Manual therapy is a non-invasive and well accepted therapeutic option. It should be considered as a gateway to exercise-based approach when aligned with patient preference.