Comparative Effects of Acupuncture Combined with Tuina versus Acupuncture Alone for Lumbar Disc Herniation

Whether adding tuina to acupuncture provides clinically important benefit for lumbar disc herniation remains uncertain. This review compared acupuncture combined with tuina with acupuncture alone.

PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang, and VIP were searched without language restrictions from the earliest available records to January 31, 2026. Randomized controlled trials comparing acupuncture combined with tuina versus acupuncture alone were included. Outcomes were JOA score, VAS score, ODI, and overall therapeutic response. Random-effects models were used for clinically or statistically heterogeneous outcomes. Risk of bias was assessed using outcome-specific RoB 2, and certainty was assessed using GRADE. The review was retrospectively registered in PROSPERO in March 2026 (CRD420261297721).

Seventeen trials involving 1555 participants were included. The combined intervention was associated with higher JOA scores (SMD 0.74, 95% CI 0.17 to 1.31; I2=94.9%), lower VAS scores (SMD -1.42, 95% CI -1.97 to -0.87; I2=95.1%), lower ODI scores (SMD -2.08, 95% CI -3.13 to -1.03; I2=96.9%), and a higher overall therapeutic response (RR 1.12, 95% CI 1.08 to 1.17; I2=33.0%). Most outcome-specific results raised some concerns or were at high risk of bias. Certainty was very low for JOA, VAS, and ODI and low for overall therapeutic response.

Limited-certainty evidence suggests that adding tuina to acupuncture may provide a possible short-term benefit for pain and function. Substantial heterogeneity, methodological limitations, variable outcome definitions, and possible small-study effects preclude firm conclusions about clinical superiority.