Comparative Effects of Therapeutic Exercise and Manual Therapy Techniques on Self-Reported Disability in Chronic Non-Specific Low Back Pain: A Network Meta-Analysis

Background/Objectives: Chronic non-specific low back pain is a leading cause of disability. Although therapeutic exercise and manual therapy are commonly recommended, their relative effects are often interpreted using broad therapeutic categories. This network meta-analysis aimed to compare the relative effectiveness of specific therapeutic exercise and manual therapy techniques on post-treatment self-reported disability in adults with chronic non-specific low back pain. Methods: A systematic review and frequentist random-effects network meta-analysis were conducted according to Cochrane recommendations and PRISMA-NMA guidance. The protocol was registered in PROSPERO (CRD42022331411). Randomized controlled trials including adults aged 18–65 years with chronic non-specific low back pain were searched in CENTRAL, PubMed, PEDro, Google Scholar, and SciELO up to 31 March 2026. Disability was assessed using the Roland–Morris Disability Questionnaire or Oswestry Disability Index. Effects were synthesized as standardized mean differences. Risk of bias was assessed with RoB 2, and confidence in network estimates was evaluated using CINeMA. Results: Forty-five studies were included. Compared with control/placebo, the largest favorable estimates were observed for equipment-based Pilates, stabilization with motor control, stabilization exercise, soft tissue manipulation, and Pilates Mat. Equipment-based Pilates showed the largest favorable estimate with moderate-confidence evidence, and soft tissue manipulation also showed moderate-confidence evidence. However, heterogeneity was substantial, and confidence in most favorable exercise estimates was low. Conclusions: Specific exercise and manual therapy techniques may reduce post-treatment disability in adults with chronic non-specific low back pain. Equipment-based Pilates and soft tissue manipulation showed favorable signals supported by moderate-confidence evidence. However, the findings do not support a definitive hierarchy of efficacy or categorical superiority of therapeutic exercise over manual therapy.