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BACKGROUND: Low back pain (LBP) is a prevalent musculoskeletal condition often associated with lumbar instability, resulting from structural and functional spinal deficits. This instability leads to pain, reduced function, and diminished quality of life. Physiotherapy aims to restore stability, enhance strength, and improve neuromuscular control. This systematic review examines the effectiveness of physiotherapy in managing lumbar instability and its symptoms. RESEARCH QUESTIONS: Do physiotherapy interventions reduce pain in individuals with lumbar instability? Do they improve functional abilities and neuromuscular control? What is the role of adjunct techniques such as respiratory resistance training and neurodynamic interventions? OBJECTIVES: To assess the effectiveness of physiotherapy in reducing pain, improving function, and enhancing muscle activation in individuals with lumbar instability. DESIGN: Systematic review (PROSPERO ID: CRD42025610915). METHODS: Studies involving patients with lumbar instability were identified through searches on PubMed and Google Scholar using the terms: (PHYSIOTHERAPY MANAGEMENT) AND (LUMBAR INSTABILITY). Outcomes assessed included spinal stability, strength, pain, and quality of life. RESULTS: Seventeen studies met the inclusion criteria. Lumbar stabilisation exercises, alone or combined with techniques such as respiratory resistance, whole-body vibration, or neurodynamic approaches, effectively reduced pain and improved function. Individualised and progressive programs showed greater benefits in muscle activation and overall well-being. CONCLUSION: Physiotherapy, particularly lumbar stabilisation exercises, is effective in managing lumbar instability. Adjunct techniques enhance outcomes, supporting the use of tailored, evidence-based interventions.