Physiotherapy Management of Nonspecific Low Back Pain: A Narrative Review of Contemporary Evidence

Abstract

Nonspecific low back pain (NSLBP) is among the most common musculoskeletal disorders globally and remains a leading cause of disability. Because it is not attributable to a specific identifiable pathology, NSLBP is best understood as a heterogeneous condition influenced by biomechanical, neurophysiological, psychological, and social factors. This structured narrative review summarizes contemporary evidence on physiotherapy management of NSLBP, focusing on clinical practice guidelines and evidence-based rehabilitation. Publications were identified through searches of PubMed, Scopus, and the Cochrane Library covering January 2017 to May 2026, supplemented by reference-list screening; 39 publications were included in the final synthesis. The current evidence supports an active, individualized, and biopsychosocially informed care model for NSLBP. Education, advice to remain active, self-management support, and exercise-centered rehabilitation form the foundation of treatment. Different exercise approaches, including muscle strengthening, motor control, aerobic, walking-based, and aquatic exercise, can be effective, and the choice should be individualized. Manual therapy may be used as a short-term adjunct, whereas routine reliance on passive modalities such as traction, ultrasound, and electrotherapy is not supported. Psychologically informed and multidisciplinary rehabilitation is increasingly important in chronic NSLBP. Overall, the evidence supports a shift toward education-based, exercise-focused, and patient-centered physiotherapy for NSLBP.