Comparative efficacy of traditional Chinese exercises in low back pain: a systematic review and network meta-analysis

Low back pain (LBP) is becoming increasingly common and has a significant negative impact on the physical and mental health of patients. A certain number of studies have been conducted on traditional Chinese exercises (TCEs) to treat LBP. However, the optimal treatment remains uncertain. The aim of this study was to systematically review the literature and perform a network meta-analysis (NMA) to compare the efficacy of different TCE and combination therapies for clinical practice.

We systematically searched 8 databases from inception to February 2025 for randomised controlled trials (RCTs) of TCE for LBP. The risk of bias was evaluated using the RoB 2.0 tool, and the overall quality of evidence was assessed using the GRADE approach. NMA was conducted using Bayesian theory-based R 4.5.1 and STATA 16.0 software, focusing on pain and dysfunction. In addition, we critically reviewed the methodological limitations and potential bias of the included studies.

This NMA included 38 eligible studies involving 2944 patients and 10 interventions: four standalone TCEs, four TCE combined with conventional treatment (CT), CT alone, and no intervention. Key findings indicated that: (a) wuqinxi was most effective for pain reduction [Visual Analogue Scale (VAS)]; (b) yijinjing + CT, taiji + CT, and yijinjing alone showed superior improvement in dysfunction [Oswestry Disability Index (ODI)/Japanese Orthopaedic Association (JOA)/Roland-Morris Disability Questionnaire (RMDQ)]; (c) yijinjing optimized lumbar flexion and extension range of motion (ROM), while baduanjin + CT enhanced lateral flexion ROM; and (d) taiji + CT achieved the highest total effective rate.

TCEs and their combinations with CT may effectively improve pain, dysfunction, joint movement and overall efficacy in LBP. Wuqinxi, yijinjing + CT, taiji + CT, baduanjin + CT and yijinjing appear to be the most beneficial interventions. However, this study has limitations including notable heterogeneity and potential publication bias across some included studies. High-quality RCTs with standardized protocols and long-term follow-up are needed to validate these results and address clinical uncertainty.