TCM tuina therapy as effective as physiotherapy for short-term relief of lower back pain: SGH study

SINGAPORE – Tuina, a Traditional Chinese Medicine (TCM) therapeutic massage, is as effective as physiotherapy for treating chronic lower back pain in the short term, a study by the Singapore General Hospital (SGH) has found.

For the long term, however, physiotherapy remains a mainstay treatment, it said.

The study, the first in Singapore to compare a TCM treatment with physiotherapy, found pain scores for those receiving tuina therapy by a registered TCM practitioner or a combination of tuina therapy and physiotherapy were comparable to those undergoing physiotherapy after two months of treatments.

However, after five months, patients who underwent physiotherapy or a combination of physiotherapy and tuina therapy were better able to perform daily activities, such as walking, sitting or lifting objects, than those who received only tuina therapy.

The study’s authors said this is likely because patients who underwent physiotherapy continued to do the exercises at home.

Study participant Erica Ong, 63, said she receives the best of both worlds with the two treatments. She does the tailored physiotherapy exercises at home for about 10 to 15 minutes, up to three times a week, to manage her back pain.

SGH senior principal physiotherapist Celia Tan said: “When you’re using a very direct contact (tuina) treatment, there’s the tendency for them to feel that the pain is coming back (when treatment stops).”

“For physiotherapy, we tend to use more self-treatment exercises... to get them to be responsible for their treatment,” Professor Tan said during a media briefing on May 12.

The therapeutic form of tuina done in a TCM clinic works on the same meridians and acupoints as acupuncture but uses manual pressure instead of needles. Stimulating these points removes energy blockages to restore the free flow of energy, or qi, and blood. Tuina is sometimes referred to as “acupuncture without needles”.

It is used to treat various medical problems, including back pain and frozen shoulder. It differs from spa tuina, which is primarily a relaxation massage offered by massage practitioners.

Findings similar to those from SGH were also reported by the Mayo Clinic in the United States and Jinan University’s School of TCM in Guangzhou, China. All three are part of a multi-centre trial, said Professor Tay Boon Keng, emeritus consultant at the Department of Orthopaedic Surgery at SGH.

The Head Foundation, which funded the research in all the centres, said that combined results from the three centres are being analysed to provide a comprehensive view of chronic back pain treatments across different ages, ethnicities and cultural backgrounds.

A fourth centre in Malaysia is now studying the effects of combining tuina with physiotherapy for chronic lower back pain in a single session lasting not more than 45 minutes, said Prof Tay.

For the SGH study, 204 patients up to the age of 75 were recruited between March 2021 and January 2023. These patients, who had lower back pain that were not caused by a specific injury or disease, were randomly assigned to three groups.

The first group received six sessions of physiotherapy at the hospital, while the second had six sessions of tuina by registered TCM physicians from the Academy of Chinese Medicine Singapore. The third group underwent three sessions each of both treatments.

These sessions, each lasting 20 to 30 minutes, took place over two months. They were followed up at five months.

TCM practitioner Ho Chin Ee, vice-president of the Academy of Chinese Medicine Singapore, said that while tuina offers quick relief, the study gave her insights into the benefits of physiotherapy.

“If it’s chronic pain, I can solve your pain but the relief (lasts) maybe a few months. The tendency is that you will have to come back to me,” she said. For the longer term, tuina patients can opt to do physiotherapy as well to improve the outcomes, she added.

Prof Tay said SGH plans to study other potential applications of tuina therapy, including for shoulder and knee pain, as well as neurological conditions. The National Neuroscience Institute will soon start recruiting patients for a study on the impact of tuina on patients with insomnia, he said.

TCM tuina therapy is not a subsidised treatment in Singapore’s current mainstream healthcare landscape.

In late 2024, Health Minister Ong Ye Kung had said that TCM practitioners may partner Western doctors under an expanded Healthier SG programme in the future.

The Ministry of Health has since launched a TCM sandbox initiative to test specific treatments within the public healthcare system to see if they can safely and effectively complement Western medicine.