Therapeutic exercise is effective in reducing the intensity of non-specific low back pain in children and adolescents: a systematic review and network meta-analysis: Exercise reduces low back pain.

Objective: To compare the different physiotherapy treatments and determine the most effective treatment to reduce the non-specific low back pain (NSLBP) intensity in children and adolescents.

Data sources: Eight databases (Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, PsycINFO and SCOPUS), and two health-specialized journals (BMJ and Spine) were searched from inception to May 2023, with no language restriction.

Study selection: Individuals aged 6 to 18 years with NSLBP were selected, and physical therapy treatments were considered. Studies were required to be controlled clinical trials with pretest and posttest evaluations, and to report pain intensity.

Data extraction: Data extraction and risk of bias assessment were performed independently by two reviewers.

Data synthesis: A meta-analysis of 11 controlled trials with 827 participants found that physiotherapy treatments effectively reduced NSLBP intensity on posttest measurement (d₊ = 0.75, 95% CI= 0.30-1.20) and six-month follow-up (d₊ = 0.35, 95% CI= -0.72-1.40). Network meta-analysis showed both therapeutic exercise (d₊ = 1.11, 95% CI= 0.48-1.74) and a combination of therapeutic exercise and manual therapy (d₊ = 1.45, 95% CI= 0.40-2.49) were effective compared to no treatment. There were no significant differences between therapeutic exercise and the combination of therapeutic exercise and manual therapy.

Conclusion: Physical exercise has proven to be the most effective treatment for addressing the intensity of NSLBP in children and adolescents. While combining it with manual therapy may yield even better results, it is crucial to emphasize that physical exercise should serve as the cornerstone in the physiotherapeutic approach to managing NSLBP intensity in this age group.