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Peer-reviewedCC BYJournal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology

Advances in physiotherapy for chronic low-back pain: a level I systematic review.

  • Filippo Migliorini1,2,3
  • Nicola Maffuli4,5,6
  • Luise Schäfer7,8
  • Nicola Manocchio9
  • Michela Bossa10
  • Calogero Foti9
10 affiliations
  1. 1Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Street 40, 06097, Halle, Saale, Germany. [email protected].
  2. 2Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy. [email protected].
  3. 3Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy. [email protected].
  4. 4Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University "La Sapienza" of Rome, Rome, Italy.
  5. 5School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, UK.
  6. 6Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK.
  7. 7Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Street 40, 06097, Halle, Saale, Germany.
  8. 8Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
  9. 9Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy.
  10. 10Behavioral Neuropsychology Laboratory, I.R.C.C.S. "Santa Lucia" Foundation, Rome, Italy.
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Abstract

Background

Non-pharmacologic management of chronic low back pain (cLBP) should be considered the first-line treatment. However, consensus guidelines and internationally accepted recommendations on the therapeutic algorithm are missing. The present level I systematic review presents a qualitative analysis of advancements in physiotherapy over the past decades to discuss the role of physical and rehabilitation medicine in the management of cLBP.Methods

In August 2025, the following databases were accessed: PubMed, Web of Science and Embase. All randomised controlled trials evaluating the efficacy of physiotherapy programs in patients with cLBP were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The data extraction and risk-of-bias evaluation were performed independently by two authors.Results

Data from 150 randomised controlled trials (RCTs) (12,773 patients) were collected. The mean symptom duration was 61.2 ± 51.0 months, and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years, and the mean body mass index (BMI) was 25.8 ± 2.9 kg/m2.Conclusions

Managing cLBP is challenging. While individual investigations highlight the efficacy of a specific intervention, most cLBP management strategies share common elements. Combining key elements from various approaches may prove crucial. Although this result is not decisive for treatment, it paves the way for further research that considers a more holistic and multidisciplinary approach.

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Cite

BibTeXRIS
BibTeX
@article{migliorini2026advances,
  title = {{Advances in physiotherapy for chronic low-back pain: a level I systematic review.}},
  author = {Filippo Migliorini and Nicola Maffuli and Luise Schäfer and Nicola Manocchio and Michela Bossa and Calogero Foti},
  journal = {Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology},
  year = {2026},
  month = oct,
  doi = {10.1186/s10195-026-00972-0},
  url = {https://europepmc.org/article/MED/42900415},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Advances in physiotherapy for chronic low-back pain: a level I systematic review.
AU  - Filippo Migliorini
AU  - Nicola Maffuli
AU  - Luise Schäfer
AU  - Nicola Manocchio
AU  - Michela Bossa
AU  - Calogero Foti
PY  - 2026
DA  - 2026/10/18
JO  - Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
DO  - 10.1186/s10195-026-00972-0
UR  - https://europepmc.org/article/MED/42900415
AB  - Background  Non-pharmacologic management of chronic low back pain (cLBP) should be considered the first-line treatment. However, consensus guidelines and internationally accepted recommendations on the therapeutic algorithm are missing. The present level I systematic review presents a qualitative analysis of advancements in physiotherapy over the past decades to discuss the role of physical and rehabilitation medicine in the management of cLBP.Methods  In August 2025, the following databases were accessed: PubMed, Web of Science and Embase. All randomised controlled trials evaluating the efficacy of physiotherapy programs in patients with cLBP were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The data extraction and risk-of-bias evaluation were performed independently by two authors.Results  Data from 150 randomised controlled trials (RCTs) (12,773 patients) were collected. The mean symptom duration was 61.2 ± 51.0 months, and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years, and the mean body mass index (BMI) was 25.8 ± 2.9 kg/m2.Conclusions  Managing cLBP is challenging. While individual investigations highlight the efficacy of a specific intervention, most cLBP management strategies share common elements. Combining key elements from various approaches may prove crucial. Although this result is not decisive for treatment, it paves the way for further research that considers a more holistic and multidisciplinary approach.
SN  - 1590-9921
SN  - 1590-9999
ER  -