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Short answer
In chronic non-specific low back pain, osteopathic treatment reduces pain by an average of approximately 13 points on a 100-point scale for up to 3 months. However, in studies comparing it with sham (placebo) treatment the difference was small or was not detected, and in acute low back pain no benefit has been shown. The NICE guideline recommends manual therapy only as part of a treatment package that also includes exercise.
Low back pain is the most extensively studied area of osteopathic treatment.
What is known?
According to a meta-analysis of 15 randomised trials, in chronic non-specific low back pain osteopathic treatment reduces pain by an average of approximately 13 points on a 100-point scale for up to 3 months and slightly improves function. The quality of the evidence is moderate. A reduction in pain has also been observed in low back and pelvic pain during pregnancy (an average of approximately 17 points).
What is not known?
In studies comparing osteopathic treatment with sham (placebo) treatment, the results are more modest. In a study involving 400 patients, the difference in functional limitation was small and its clinical significance was judged to be doubtful, while no difference in pain was detected. Another meta-analysis likewise found no advantage over sham treatment in terms of pain or functional limitation. In acute low back pain, no benefit has been shown.
What do clinical guidelines recommend?
The NICE guideline in the United Kingdom recommends considering manual therapy for low back pain only as part of a treatment package that also includes exercise.
On imaging
According to a systematic review of studies conducted in people without pain, changes such as disc degeneration are found in 37% of 20-year-olds and in 96% of 80-year-olds. Many of the changes detected on MRI are therefore part of natural ageing and may not be the cause of the pain. Images must always be interpreted together with the clinical picture.
Conclusion
In low back pain, osteopathic treatment can be a complementary approach applied together with active exercise and patient education. Before treatment, the signs of serious disease — the red flags — must always be checked.
Sources
- Franke H. et al. (2014). Osteopathic manipulative treatment for non-specific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. DOI: 10.1186/1471-2474-15-286 (opens in a new window)
- Franke H. et al. (2017). Osteopathic treatment for low back and pelvic pain during and after pregnancy. J Bodyw Mov Ther. DOI: 10.1016/j.jbmt.2017.05.014 (opens in a new window)
- Nguyen C. et al. (2021). Osteopathic treatment compared with sham treatment for chronic low back pain: a randomised trial. JAMA Intern Med. DOI: 10.1001/jamainternmed.2021.0005 (opens in a new window)
- Ceballos-Laita L. et al. (2024). Osteopathic treatment compared with sham treatment: a meta-analysis. Diseases. DOI: 10.3390/diseases12110287 (opens in a new window)
- Zipp et al. (2025). An overview of systematic reviews on osteopathy. J Bodyw Mov Ther. DOI: 10.1016/j.jbmt.2025.03.018 (opens in a new window)
- NICE NG59 (2016, with 2026 amendments). Low back pain and sciatica: assessment and management. nice.org.uk (opens in a new window)
- Brinjikji W. et al. (2015). Imaging findings of degenerative spinal changes in people without pain: a systematic review. AJNR Am J Neuroradiol, 36(4):811–816. DOI: 10.3174/ajnr.A4173 (opens in a new window)
This article is for educational purposes and does not replace a physician's advice.