Evidence-Based Manual Therapy Techniques for Low Back Pain

Evidence-Based Manual Therapy Techniques for Low Back Pain

To go along with today’s episode I have a nice infographic to share…

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• FPF Mini Course – 7 Reasons Why Injuries Happen in the Gym and What to do About it
• The Fitness Pain Free Certification

In today’s video we go over Evidence-Based Manual Therapy Techniques for Low Back Pain: 

Tired of the “manual therapy is useless” debate? The research shows small, short-term effects for nonspecific low back pain. But for the right patient, a technique that helps them feel better in the moment can make a huge difference, especially when it’s paired with education and exercise.

In this video I breaks down what the evidence says and demonstrates the hands-on techniques I use with his own patients.

IN THIS VIDEO YOU’LL LEARN:

What the research says about spinal manipulation, mobilization, massage, and soft tissue work for low back pain

How to perform a side-lying lumbar spinal manipulation, including positioning, flexion/extension bias, and how to calm an anxious patient

How to do PA and UPA mobilizations without destroying your thumbs

How to palpate the paraspinals and quadratus lumborum (QL) and find the area that’s relevant to your patient’s pain

How to use cupping, instrument-assisted tools, fist, elbow, and finger techniques (cross friction, ischemic compression, pin and stretch)

How to reach the QL, which is hidden between the ribs and pelvis, in side-lying and child’s pose

How much pressure to use (“strong but comfortable”)

How to choose the right treatment position so your patient doesn’t leave feeling worse

 SOUND FAMILIAR?

• Patients who expect hands-on care, but you’re unsure how much it will really help
• Effect sizes that look small, and colleagues who make you feel guilty for using manual therapy
• Aching thumbs, wrists, and knuckles after a full day of soft tissue work
• Patients who grit their teeth through painful treatment and never tell you
• A patient who feels worse after a session because of the position they were in
• Not knowing which technique to pick, or what to do when it isn’t working

TIMESTAMPS

• 0:00 – Do manual therapies work for low back pain?
• 1:59 – Side-lying lumbar spinal manipulation
• 5:36 – Side-lying mobilization, stretch, and contract-relax
• 6:44 – PA and UPA mobilizations
• 9:35 – Finding the paraspinals and QL
• 11:19 – Patient positioning: what feels good vs. what doesn’t
• 12:31 – Palpation to find the relevant pain
• 13:23 – Cupping and instrument-assisted soft tissue mobilization
• 15:30 – Fist technique
• 17:17 – Elbow technique and pin and stretch
• 19:20 – Finger techniques: cross friction, circles, ischemic compression
• 20:45 – Handlebar tool in child’s pose
• 21:52 – QL techniques in side-lying
• 26:02 – How much pressure should you use?
• 26:30 – Do you have to use manual therapy? 

Blasting pain with your own hands,

– Dan Pope DPT,OCS,CSCS

Show Notes / Relevant Articles:

• FPF Mini Course – 7 Reasons Why Injuries Happen in the Gym and What to do About it
• Lower Extremity Reflex Testing: Guide for Physical Therapists [Disc Bulge, Herniation Diagnosis]
• Myotome Testing of the Lower Extremity: Peripheral Neurological Examination
• How I Evaluate Radicular Low Back Pain from a Herniated Disc [Physical Therapy Guide]
• Physical Therapy Treatment for Radicular Lower Back Pain During Squats, Deadlifts and Olympic Lifts:
• Disc Herniation and Radicular Low Back Pain EVIDENCE BASED GUIDE for Physical Therapists

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Thank you!

Dan Pope DPT, OCS, CSCS

References: 

1. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019 Mar 13;364:l689. doi: 10.1136/bmj.l689. PMID: 30867144; PMCID: PMC6396088.
2. Cashin AG, Chou R, Weimer MB, McAuley JH. Low Back Pain: A Review. JAMA. 2026;336(2):144–158. doi:10.1001/jama.2026.9631
3. Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Suttorp Booth M, Herman PM. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J. 2018 May;18(5):866-879. doi: 10.1016/j.spinee.2018.01.013. Epub 2018 Jan 31. PMID: 29371112; PMCID: PMC6020029.
4. Güzelşemme S, Oksüz S. Comparison of Passive and Active Application of Instrument-Assisted Soft Tissue Mobilization in Individuals with Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial. Altern Ther Health Med. 2025 Oct;31(6):14-20. PMID: 40492753.
5. Chen PC, Wei L, Huang CY, Chang FH, Lin YN. The Effect of Massage Force on Relieving Nonspecific Low Back Pain: A Randomized Controlled Trial. Int J Environ Res Public Health. 2022 Oct 13;19(20):13191. doi: 10.3390/ijerph192013191. PMID: 36293771; PMCID: PMC9602448.
6. Thomas JS, Clark BC, Russ DW, et al. Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(8):e2012589. doi:10.1001/jamanetworkopen.2020.12589