Abstract
Lumbar spine pain (LBP) is a leading cause of disability worldwide and remains a major challenge in clinical practice. Among non-invasive treatment strategies, manual therapy plays a central role, offering individualized interventions that target both biomechanical dysfunction and pain. This narrative review compares three commonly used physiotherapeutic approaches-Kaltenborn-Evjenth mobilization, the McKenzie method, and high-velocity low-amplitude (HVLA) manipulation-based on current evidence regarding their effectiveness, safety, and clinical application. A total of 32 randomized controlled trials, systematic reviews, and meta-analyses published between 2003 and 2024 were analyzed. The Kaltenborn-Evjenth method demonstrated notable effectiveness in improving range of motion and reducing chronic pain, particularly in patients with segmental hypomobility. The McKenzie method showed strong outcomes in both acute and chronic LBP, especially in cases involving symptom centralization and high patient engagement. HVLA techniques offered rapid symptom relief in acute phases but required careful patient selection due to their mechanical intensity. The findings suggest that no single method is universally superior. Instead, optimal outcomes are achieved through individualized treatment plans that integrate multiple techniques based on clinical presentation, pain chronicity, and functional limitations. Multimodal strategies that combine manual therapy with exercise and patient education appear to be the most effective in managing LBP and preventing recurrence.