Efficacy of Traditional Chinese Exercises on Chronic Low Back Pain: A Systematic Review and Network Meta-analysis

Chronic low back pain (CLBP) is a global health problem. Traditional Chinese exercises (TCEs) may relieve pain and improve physical function, but evidence to guide TCE selection remains limited. This study compared the efficacy of different TCEs on pain and functional outcomes in adults with CLBP.

Seven databases and grey-literature sources were searched for randomized controlled trials (RCTs) of TCEs for CLBP from inception to August 2, 2026. Study quality and evidence certainty were assessed using risk-of-bias tools, the NIH Quality Assessment Tool, and the CINeMA framework. Data were analysed using the R package gemtc, standardized mean differences (SMDs) with 95% credible intervals (CrIs) were calculated.

Forty-three RCTs involving four TCE modalities were included. On the Visual Analogue Scale (VAS), statistically significant pain reduction was only observed for TCEs combined with conventional therapy (CT); Yijinjing+CT showed the largest numerical effect, followed by Taichi+CT and Baduanjin+CT. Significant Oswestry Disability Index (ODI) improvements occurred with Baduanjin+CT and Wuqinxi+CT. Baduanjin+CT, Wuqinxi+CT, and Yijinjing+CT improved Japanese Orthopaedic Association (JOA) scores. Evidence certainty was low-to-moderate across outcomes.

TCE+CT produced large effect estimates for CLBP-related pain and physical function. Although surface under the cumulative ranking curve (SUCRA) rankings favoured Yijinjing+CT for pain relief and Wuqinxi+CT for functional improvement, no statistically significant head-to-head differences were identified among effective combined regimens, precluding definitive ranking of superiority. Given low-to-moderate certainty, clinical decisions should consider patient preferences and intervention accessibility.