Additional file 1.docx

Nonspecific chronic low back pain (NSCLBP) is a widespread musculoskeletal disorder, representing 85% of chronic low back pain cases. It persists for over three months and is often associated with psychosocial factors and abnormal pain responses. Although pharmacological treatments are common, patients frequently seek active interventions like physiotherapy, exercise, and manual therapy. This systematic review evaluates the effectiveness of spinal manipulation, either alone or in combination with therapeutic exercises, in managing NSCLBP.