According to the CDC, 24.3% of U.S. adults experienced chronic pain (defined as pain most days or every day in the past three months) in 2023, and 8.5% as high-impact chronic pain—pain that frequently limited life or work activities.

At Physio Osteo, we integrate physiotherapy (including modalities, therapeutic exercises, and neuromuscular rehabilitation) with manual osteopathy. This combination has strong evidence from research. 

Evidence from high-quality systematic reviews and meta-analyses supports posterior-chain resistance training (PCRT) and manual therapy as an adjunct to exercise for managing chronic low back pain (CLBP).

A systematic review in Sports Medicine – Open (2021) analyzed randomized controlled trials comparing PCRT to general exercise or walking in adults with CLBP (≥12 weeks). PCRT programs (12–16 weeks, targeting glutes, hamstrings, erector spinae, etc.) produced significantly greater improvements in pain, disability, and muscle strength, with no increase in adverse events, and were recommended as a preferred intervention for CLBP rehabilitation (Vannatta et al., 2021).

Separately, a 2025 systematic review in the Journal of Bodywork & Movement Therapies examined RCTs comparing exercise alone to exercise plus manual therapy (spinal manipulation, mobilization, soft tissue techniques) in CLBP. Out of 10 RCTs, 8 reported superior short-term pain and disability improvements with the combined approach, while 2 found no difference. Benefits were most pronounced in the short term, with long-term outcomes largely driven by the exercise component (Alhabeeb et al., 2025).

Together, these findings suggest that a posterior-chain–focused strengthening program is an evidence-based core treatment for CLBP, and adding manual therapy can enhance early pain relief and functional gains, facilitating better engagement in active rehabilitation.

References:

1. Vannatta CN, Banerjee M, Teyhen DS, Childs JD, Van Dillen LR, Sahrmann SA, et al. Posterior-chain resistance training compared to general exercise and walking programmes for the treatment of chronic low back pain: A systematic review and meta-analysis. Sports Med Open. 2021;7(1):47. doi:10.1186/s40798-021-00306-w.
2. Alhabeeb AA, Alotaibi NM, Shousha TM, Teyhen DS, Childs JD. Does the addition of manual therapy to exercise therapy improve pain and disability outcomes in chronic low back pain: A systematic review. J Bodyw Mov Ther. 2025;33:45–56. doi:10.1016/j.jbmt.2024.10.012.