Tuina for chronic non-specific low back pain: A systematic review and meta-analysis of randomized controlled trials

Chronic non-specific low back pain (cNLBP) is a pervasive and debilitating condition with significant personal, societal, and economic burdens. Despite its prevalence, effective and sustainable non-pharmacological treatment options remain limited. Here, we compared the efficacy of Tuina versus non-Tuina interventions in adults with cNLBP. PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, CBM, WanFang, and VIP were searched from inception to April 2025. The Cochrane Risk of Bias tool and the GRADE approach were applied to assess risk of bias and certainty of evidence. Twenty-one trials (1612 participants) were included. Compared with control interventions, Tuina showed greater pain reduction (SMD = -1.06, 95% CI: [-1.37, -0.76], p < 0.00001, GRADE: low), better functional improvement (SMD = -1.17, 95% CI: [-1.62, -0.72], p < 0.00001, GRADE: low), and superior clinical effectiveness (OR = 3.84, 95% CI: [2.42, 6.11], p < 0.00001, GRADE: low). No significant differences were found in muscle fitness (SMD = 1.42, 95% CI: [-0.00, 2.83], p = 0.05, GRADE: very low) or incidence of serious adverse events. Tuina effectively treats cNLBP, offering substantial pain relief and functional improvements, though it has no significant impact on muscle fitness. Future work should consider standardized protocols and more rigorously designed trials to support clinical recommendations. This study has been registered with the PROSPERO platform (registration no. CRD420251051014).