Background: Crenobalneotherapy is commonly used to treat low back pain (LBP), but evidence from previous reviews was not sufficient. This systematic review aimed to identify the best evidence for the clinical effect of crenobalneotherapy in LBP.

Methods: We systematically searched MEDLINE via PubMed, PEDRO and the Cochrane Central Register of Controlled Trials for articles published up to January 2016. Articles were included if trials were comparative, if one or more of the subgroups had LBP with separate data, and if spa therapy or any hydrotherapy techniques involving mineral water or mineral mud was compared to any other intervention or no treatment. Statistical validity, external validity and quality of side-effects assessment were evaluated by personal checklists. Risk of bias (internal validity) was assessed by the CLEAR NTP.

Results: The spa therapy, as a multicomponent treatment, seems capable to improve pain, functional capacity and sometimes drug consumption or quality of life in short and medium term in LBP. Radon-based treatment and carbon dioxide injections do not appear to provide any additional benefit to multicomponent treatment delivered in spa centers. Spa therapy seems to be well tolerated. More rigorous studies are needed to confirm these findings.