Utilization patterns and perceived effectiveness of manual therapy for low back pain among Saudi physical therapists: a national cross-sectional study

Low back pain (LBP) is a leading cause of disability worldwide, and manual therapy (MT) is commonly used in its management. However, utilization patterns and perceived effectiveness vary according to training and clinical context, with limited national-level evidence describing how Saudi physical therapists apply MT in routine LBP care. To examine national patterns of MT utilization for LBP among licensed Saudi physical therapists, to identify commonly applied techniques, and to evaluate professional and educational factors associated with perceived effectiveness and frequency of use. A cross-sectional survey was conducted from January to March 2025 using a structured online questionnaire distributed nationwide via professional and social-media platforms. Eligible participants were Saudi Commission for Health Specialties (SCFHS)–licensed physical therapists actively managing LBP. The questionnaire assessed demographics, MT training exposure, frequency and type of MT use, perceived effectiveness, and outcome-measurement practices. Content validity was confirmed by six experts (S-CVI/Avg = 0.96). Data were analyzed using descriptive statistics, chi-square tests, Spearman’s rho correlation, and multivariable ordinal logistic regression (SPSS v28; α < 0.05). Of 182 responses received, 173 met the inclusion criteria. Most participants reported using MT for LBP management, with 89% employing it at least occasionally and 20% reporting routine use. MT was rated as important or very important by 87.9% of respondents, and more than half assigned a perceived usefulness score ≥ 6/10. Greater exposure to MT training was independently associated with higher MT utilization and stronger perceived effectiveness ( p < 0.001; Nagelkerke R² = 0.47), whereas years of experience and clinical specialization were not significantly associated. MT is widely used and positively perceived by Saudi physical therapists managing LBP. Variability in its utilization and perceived effectiveness appears primarily related to differences in training exposure. These findings describe current practice patterns and professional perceptions and may inform future educational planning, without inferring clinical effectiveness.