A network meta-analysis of 26 randomized controlled trials compared aquatic exercise, balneotherapy, land exercise and their combinations with general care in chronic non-specific low back pain (CLBP). Balneotherapy + general care (SMD=2.51, 95% CI 1.26–3.76), water exercise + general care (SMD=1.96), water exercise (SMD=1.58) and land exercise (SMD=1.45) were significantly effective for pain compared to blind control. According to SUCRA, balneotherapy + general care took first place (SUCRA=0.92, PrBest=61.4%). Balneotherapy + general care (SMD=2.76), balneotherapy (SMD=2.48), balneotherapy + exercise on land (SMD=2.06) and water exercise (SMD=2.03) were significant for disability (disability). Multimodal programs with hydrotherapy showed greater improvements than single interventions, but the evidence is limited by high heterogeneity (I²>85%) and low to very low certainty (94.4% of comparisons for pain). The study is registered at PROSPERO (CRD42023432018).