Tuina as effective as physiotherapy for chronic low back pain

Tuina as effective as physiotherapy for chronic low back pain

Tuina (TN), both alone and in combination with physiotherapy (PT), is an effective treatment for chronic nonspecific low back pain (CNLBP), with benefits persisting for up to 20 weeks, according to Chinese researchers. Two hundred and four CNLBP patients were randomly assigned to receive TN, PT or a combination of TN and PT (TP). TN treatment involved passive movements focusing on promoting meridian flow, relieving spasms and pain, promoting circulation and adjusting tendons. Treatment areas included the lumbar and sacral regions, buttocks and lower limbs. Key acupoints included Shenshu BL-23, Dachangshu BL-25, Xiaochangshu BL-27, ashi points, Weizhong BL-40 and Huantiao GB-30. Acupoints were added based on patients’ individual conditions, such as Yanglingquan GB-34 for damp-heat conditions, Yaoyangguan DU-3 for cold-damp, Geshu BL-17 for blood stasis and Mingmen DU-4 and Taixi KID-3 for Kidney deficiency. PT followed a five-step treatment approach, consisting of patient education, manual therapy, aerobic exercise, flexibility and core strengthening exercises, and a home exercise plan. The combined TP treatment involved a combination of active movement and passive manual therapy, but delivered at alternating treatment sessions. All participants underwent a total of six 30-minute treatment sessions over eight weeks, with follow-ups conducted at week 9 and week 20. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), Range of Motion (ROM), Traditional Chinese Medicine Syndrome Scale (TCMSS), and adverse event (AE) reporting. All three groups exhibited significant reductions in VAS scores post-treatment and at the 20-week follow-up, indicating lasting pain relief. Secondary outcomes, including ODI and TCMSS scores, also improved significantly, particularly in functional disability and TCM symptoms. Pairwise comparisons highlighted notable reductions in ODI scores, with clinical relevance, although no significant differences were observed between treatment groups. Improvements in ROM and SF-36 were statistically significant, but not clinically impactful. Only one adverse event (0.49%) was reported, and no severe incidents occurred. The authors conclude that TN, PT, and TP are all effective in reducing pain and improving functional outcomes in CNLBP patients, with benefits lasting up to 20 weeks. They highlight that TN, which involves only passive movements, may be especially suitable for patients who cannot participate in active exercise. The study supports incorporating TN and TP as complementary therapies for CNLBP, offering clinicians effective tools to customise treatment strategies based on individual patient needs and preferences. The findings demonstrate that TN, PT, and TP are all effective in reducing pain and improving functional outcomes for CNLBP patients, with benefits persisting for up to 20 weeks. (Tuina versus physiotherapy or a combination of both for the management of chronic nonspecific low back pain: A randomized controlled trial. Complement Ther Med. 2024 Nov:86:103098).

https://pubmed.ncbi.nlm.nih.gov/39395482/