{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:14:41Z","timestamp":1783401281529,"version":"3.54.6"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low back pain, radicular symptoms, and functional impairment are common manifestations of lumbar disc herniation (LDH), which can substantially impair patients' quality of life. Tuina therapy and core stability training are widely used conservative interventions for LDH, often applied as a combination of passive manual therapy and active exercise to alleviate symptoms and improve function. However, most existing clinical studies are limited by small sample sizes and methodological weaknesses, and robust evidence is lacking regarding whether the combined intervention is superior to either therapy alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study is a single-center, outcome assessor- and data analyst-blinded, randomized controlled trial. A total of 96 patients with LDH will be randomly allocated in a 1:1:1 ratio to the Tuina group, the core stability training group, or the combined intervention group. All participants will receive an 8-week intervention (three sessions per week), followed by a 1-month follow-up period. The primary outcome is the muscle activation ratio of the transversus abdominis assessed by musculoskeletal ultrasound. Secondary outcomes include imaging parameters, pressure biofeedback unit (PBU), the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association (JOA) score, and the 36-Item Short Form Health Survey (SF-36). Objective outcomes (musculoskeletal ultrasound, MRI, X-ray, PBU) will be assessed by researchers blinded to group allocation. Patient-reported outcomes (VAS, ODI, JOA, and SF-36) are inherently unblinded as participants are aware of their treatment assignment. Statistical analysis will be performed without knowledge of group allocation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study is expected to provide high-quality evidence on the efficacy and safety of Tuina combined with core stability training in improving lumbar stability and clinical outcomes in patients with LDH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      International Traditional Medicine Clinical Trial Registry (ITMCTR,\n                      <jats:ext-link>http:\/\/itmctr.ccebtcm.org.cn\/<\/jats:ext-link>\n                      ), identifier: ITMCTR2025001794.\n                    <\/jats:p>\n                  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