Tui Na therapy for pain and function in chronic low back pain: a systematic review

BACKGROUND: Chronic low back pain (CLBP) remains a prevalent and debilitating condition with significant social and economic impact. Due to limitations associated with pharmacological therapies, there is increasing interest in non-pharmacological approaches such as Tui Na manual therapy. This systematic review aimed to evaluate the effectiveness of Tui Na therapy in reducing pain and improving function in CLBP. METHODS: A comprehensive literature search was conducted across PubMed, Cochrane Library, EMBASE, Medline, Scopus, Web of Science and Google Scholar from inception to 30 April 2025, identifying randomised controlled trials and quasi-experimental studies evaluating Tui Na or Chuna interventions in adults (≥18 years) with chronic specific or non-specific low back pain (duration ≥12 weeks). Studies were included if they reported outcomes on pain intensity and functional status. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the quality of evidence. RESULTS: Five studies involving 618 participants were included. Tui Na (or Chuna) therapy significantly reduced pain intensity (mean Visual Analogue Scale/Numerical Rating Scale reduction: 2.5-3.1 points) and improved functional outcomes (mean Oswestry Disability Index reduction: 10-15 points) compared with control or conventional care. Improvements were consistent across both specific and non-specific CLBP subgroups. No serious adverse events were reported; mild side effects were rare and self-limiting. CONCLUSION: This review provides evidence that Tui Na and Chuna manual therapies are effective in alleviating pain and improving function in adults with CLBP. Given their favourable safety profile and consistent clinical benefits, these therapies may serve as valuable components of integrative pain management strategies.