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Clinical efficacy of chinese manual therapy for lumbar disc herniation: A systematic review and meta-analysis
De-Ta Chen1, Hai-Xia Zhu2, Zi-Jian Wan3
1Department of Orthopedics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, China; First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Chinese Medicine University, China.
Objective:
To systematically evaluate and meta-analyze the clinical efficacy of manual therapy for lumbar disc herniation (LDH), with emphasis on its effects on pain relief, functional recovery, and inflammatory modulation.
Methods:
A comprehensive search of both Chinese and international databases was performed to identify 47 randomized controlled trials (RCTs) of manual therapy for LDH. Meta-analyses were conducted using RevMan 5.4 and Stata 18.0. Primary outcomes included clinical effectiveness, pain scores, functional measures assessed by the Japanese Orthopaedic Association (JOA) score and the Oswestry Disability Index (ODI), and inflammatory cytokines (TNF-α, IL-1β, IL-6). Sensitivity analyses, publication bias assessment, and GRADE evidence grading were also performed.
Results:
A total of 4480 patients were included. Manual therapy was associated with superior clinical effectiveness (RR = 1.20, 95 % CI: 1.15-1.25), significant reductions in pain scores (SMD = 1.23, 95 % CI: 0.98-1.49), and improved functional outcomes (JOA SMD = 1.42, 95 % CI: 1.07-1.77; mean ODI reduction: 14.47 points). Limited evidence also suggested reductions in inflammatory markers, including TNF-α (SMD = 2.25), IL-1β (SMD = 1.45), and IL-6 (SMD = 0.66). Sensitivity analyses confirmed robustness of the pooled results, while publication bias was minimal. According to GRADE, the certainty of evidence was moderate for pain relief and clinical effectiveness and low for other outcomes.
Conclusion:
Manual therapy demonstrates consistent short-term benefits for patients with LDH across multiple domains, including pain, function, and inflammation. However, since most included trials were conducted in China and were of low-to-moderate methodological quality, the certainty of evidence should be considered moderate to low, and findings should be interpreted with caution. Further high-quality, multi-center international RCTs are warranted to strengthen the evidence base.
