Rizzo et al. 2025, Non-pharmacological treatments for low back pain (Cochrane overview of reviews)

Cochrane overview synthesising 31 Cochrane reviews (644 trials, 97,183 adults) examining 27 non-pharmacological and non-surgical treatments for low back pain. For acute and subacute low back pain, moderate-certainty evidence found that spinal manipulative therapy probably does not improve function compared to placebo at one week; exercise and staying active outperformed rest. For chronic low back pain, acupuncture, exercise, multidisciplinary therapy, and psychological approaches showed modest benefits. The overview’s spinal manipulation finding covered only acute and subacute low back pain, where moderate-certainty evidence found it probably does not improve function compared to placebo; the overview did not synthesise a separate chronic-LBP spinal manipulation comparison. Moderate (Cochrane overview; certainty of underlying reviews rated moderate to high confidence for most included reviews).