{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:34:07Z","timestamp":1793126047623,"version":"4.5.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,6]],"date-time":"2022-09-06T00:00:00Z","timestamp":1662422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014137","name":"Shanghai Shenkang Hospital Development Center","doi-asserted-by":"publisher","award":["16CR1023A"],"award-info":[{"award-number":["16CR1023A"]}],"id":[{"id":"10.13039\/501100014137","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012543","name":"Shanghai Science and Technology Development Foundation","doi-asserted-by":"publisher","award":["21Y21920301"],"award-info":[{"award-number":["21Y21920301"]}],"id":[{"id":"10.13039\/100012543","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012543","name":"Shanghai Science and Technology Development Foundation","doi-asserted-by":"publisher","award":["22YF1449900"],"award-info":[{"award-number":["22YF1449900"]}],"id":[{"id":"10.13039\/100012543","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009018","name":"Shanghai Municipal Human Resources and Social Security Bureau","doi-asserted-by":"publisher","award":["21PJD071"],"award-info":[{"award-number":["21PJD071"]}],"id":[{"id":"10.13039\/501100009018","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Herniation of the nucleus pulposus caused by disc degeneration and other reasons can cause low back pain and disability. In China, traditional Chinese exercises (TCEs) and traditional Chinese massage (TCM) are widely used to improve symptoms of pain and disability in patients with lumbar disc herniation (LDH). The safety and efficacy of combination therapy have not been studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the effect of traditional Chinese exercise combined with massage vs. traditional Chinese massage alone on pain, disability, lumbar mobility and gait performance in patients with LDH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Multi-center, randomized clinical trial conducted at 4 hospitals in China and enrolling 272 patients with LDH. Participants were randomly assigned to TCEs plus TCM group or TCM alone group. The combined therapy group received 18 Tai Chi training sessions (30-min sessions 3 times a week) and regular TCM treatments over 6 weeks. The control group received TCM therapy alone and was instructed to maintain their usual daily physical activity. Outcome variables measured included Visual Analog Scale (VAS), Short Form of McGill Pain Questionnaire (SF-MPQ), Oswestry Disability Index (ODI), lumbar spine range of motion (ROM) and gait performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 272 randomized participants, 259 completed the study. The mean VAS score was 51.77 mm at baseline in the TCEs plus TCM group, and 50.93 mm for the TCM alone group. The reduction in the VAS score at week 6 was greater in the TC group than in the TCM group with a mean difference of 4.05 (95% CI, 2.15\u20135.95; <jats:italic>P<\/jats:italic> &amp;lt; 0.001), and the ODI score with between-group differences of 3.57 points (95% CI, 2.84\u20134.30 points; <jats:italic>P<\/jats:italic> &amp;lt; 0.001). Similar significantly different results were observed in SF-MPQ, walking speed, cadence, and lumbar ROM. No serious adverse events were reported throughout the study period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared with TCM alone, TCEs combined with TCM treatment performed better in reducing pain and improving disability. The combination therapy could be considered a valuable treatment option for LDH patients, with potential therapeutic utility for middle-aged and elderly patients with LDH.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2022.952346","type":"journal-article","created":{"date-parts":[[2022,9,6]],"date-time":"2022-09-06T04:25:13Z","timestamp":1662438313000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":32,"title":["Effect of traditional Chinese exercise combined with massage on pain and disability in patients with lumbar disc herniation: A multi-center, randomized, controlled, assessor-blinded clinical trial"],"prefix":"10.3389","volume":"13","author":[{"given":"Xin","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingjun","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianxiang","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhizhen","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuaipan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wuquan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiafu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhao","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingguang","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2525","DOI":"10.1016\/j.spinee.2014.04.022","article-title":"Lumbar disc nomenclature: Version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American society of spine radiology and the American society of neuroradiology","volume":"14","author":"Fardon","year":"2014","journal-title":"Spine J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1056\/NEJMcp1512658","article-title":"CLINICAL PRACTICE. Herniated lumbar intervertebral disk","volume":"374","author":"Deyo","year":"2016","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1056\/NEJMra1410151","article-title":"Sciatica","volume":"372","author":"Ropper","year":"2015","journal-title":"N Engl J Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2245","DOI":"10.1056\/NEJMoa064039","article-title":"Surgery vs. prolonged conservative treatment for sciatica","volume":"356","author":"Peul","year":"2007","journal-title":"N Engl J Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2441","DOI":"10.1001\/jama.296.20.2441","article-title":"Surgical vs. nonoperative treatment for lumbar disk herniation: The Spine Patient Outcomes Research Trial (SPORT): a randomized trial","volume":"296","author":"Weinstein","year":"2006","journal-title":"JAMA."},{"key":"B6","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3174\/ajnr.A4173","article-title":"Systematic literature review of imaging features of spinal degeneration in asymptomatic populations","volume":"36","author":"Brinjikji","year":"2015","journal-title":"Am J Neuroradiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1016\/j.spinee.2013.07.456","article-title":"Recovery of motor deficit accompanying sciatica\u2013subgroup analysis of a randomized controlled trial","volume":"14","author":"Overdevest","year":"2014","journal-title":"Spine J."},{"key":"B8","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1016\/j.apmr.2011.11.028","article-title":"Recurrence of radicular pain or back pain after nonsurgical treatment of symptomatic lumbar disk herniation","volume":"93","author":"Suri","year":"2012","journal-title":"Arch Phys Med Rehab."},{"key":"B9","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1002\/ejp.1488","article-title":"Predictive factors of high societal costs among chronic low back pain patients","volume":"24","author":"Mutubuki","year":"2020","journal-title":"Euro J Pain."},{"key":"B10","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/S0140-6736(21)00733-9","article-title":"Low back pain","volume":"398","author":"Knezevic","year":"2021","journal-title":"Lancet."},{"key":"B11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.ctim.2016.01.001","article-title":"Treating low back pain resulted from lumbar degenerative instability using Chinese Tuina combined with core stability exercises: a randomized controlled trial","volume":"25","author":"Tang","year":"2016","journal-title":"Complement Ther Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1136\/bjsm.35.3.148","article-title":"Tai chi: physiological characteristics and beneficial effects on health","volume":"35","author":"Li","year":"2001","journal-title":"Brit J Sport Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"493","DOI":"10.7326\/M16-2459","article-title":"Non-pharmacologic therapies for low back pain: a systematic review for an american college of physicians clinical practice guideline","volume":"166","author":"Chou","year":"2017","journal-title":"Ann Intern Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1002\/acr.20594","article-title":"Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial","volume":"63","author":"Hall","year":"2011","journal-title":"Arthrit Care Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"628","DOI":"10.3390\/jcm8050628","article-title":"Are mindful exercises safe and beneficial for treating chronic lower back pain? A systematic review and meta-analysis of randomized controlled trials","volume":"8","author":"Zou","year":"2019","journal-title":"J Clin Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/S0003-9993(99)90121-1","article-title":"Physical performance: differences in men and women with and without low back pain","volume":"80","author":"Novy","year":"1999","journal-title":"Arch Phys Med Rehabil"},{"key":"B17","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/j.gaitpost.2005.02.006","article-title":"How do persons with chronic low back pain speed up and slow down? Trunk-pelvis coordination and lumbar erector spinae activity during gait","volume":"23","author":"Lamoth","year":"2006","journal-title":"Gait Posture"},{"key":"B18","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1007\/s00586-004-0825-y","article-title":"Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control","volume":"15","author":"Lamoth","year":"2006","journal-title":"Eur Spine J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1191\/0269215502cr463oa","article-title":"Assessment of activities of daily living with an ambulatory monitoring system: a comparative study in patients with chronic low back pain and nonsymptomatic controls","volume":"16","author":"Spenkelink","year":"2002","journal-title":"Clin Rehabil."},{"key":"B20","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/1743-0003-8-55","article-title":"Effects of obesity and chronic low back pain on gait","volume":"8","author":"Cimolin","year":"2011","journal-title":"J Neuroeng Rehabil."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1097\/MD.0000000000018781","article-title":"Expert investigation and research on the treatment of lumbar disc herniation with spinal manual therapy combined with traditional Chinese exercises","volume":"36","author":"Zhou","year":"2021","journal-title":"Chin J Rehabil Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1080\/15438627.2021.1975118","article-title":"Joint angles and joint moments of the lower limbs in four typical tai chi movements: consideration for management of knee osteoarthritis","volume":"29","author":"Zhu","year":"2021","journal-title":"Res Sports Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/S1474-4422(19)30414-4","article-title":"Long-term safety and efficacy of closed-loop spinal cord stimulation to treat chronic back and leg pain (Evoke): a double-blind, randomized, controlled trial","volume":"19","author":"Mekhail","year":"2020","journal-title":"Lancet Neurol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1016\/j.spinee.2016.06.010","article-title":"Determination of the oswestry disability index score equivalent to a \u201csatisfactory symptom state\u201d in patients undergoing surgery for degenerative disorders of the lumbar spine-a Spine Tango registry-based study","volume":"16","author":"van Hooff","year":"2016","journal-title":"Spine J."},{"key":"B25","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/0167-9457(91)90046-Z","article-title":"A gait analysis data collection and reduction technique","volume":"10","author":"Davis","year":"1991","journal-title":"Hum Movement Sci"},{"key":"B26","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.gaitpost.2018.10.031","article-title":"Spinal segments do not move together predictably during daily activities","volume":"1","author":"Enrica","year":"2018","journal-title":"Gait Posture"},{"key":"B27","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.spinee.2005.08.001","article-title":"Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations","volume":"6","author":"Santilli","year":"2006","journal-title":"Spine J."},{"key":"B28","doi-asserted-by":"publisher","first-page":"381","DOI":"10.7326\/M14-0006","article-title":"Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation","volume":"161","author":"Bronfort","year":"2014","journal-title":"Ann Intern Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.jmpt.2003.12.023","article-title":"Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment","volume":"27","author":"Oliphant","year":"2004","journal-title":"J Manip Physiol Ther."},{"key":"B30","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3109\/10582452.2013.763394","article-title":"Effectiveness of tai chi practice for Non-Specific chronic low back pain on retired athletes: a randomized controlled study","volume":"21","author":"Weifen","year":"2013","journal-title":"J Musculoskelet Pain."},{"key":"B31","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1136\/bjsm.34.1.29","article-title":"Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners","volume":"34","author":"Hong","year":"2000","journal-title":"Brit J Sport Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1093\/gerona\/60.2.187","article-title":"Tai Chi and fall reductions in older adults: a randomized controlled trial","volume":"60","author":"Li","year":"2005","journal-title":"J Gerontol A Biol Sci Med Sci."},{"key":"B33","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1016\/S0003-9993(00)90042-X","article-title":"Tai Chi Chuan to improve muscular strength and endurance in elderly individuals: a pilot study","volume":"81","author":"Lan","year":"2000","journal-title":"Arch Phys Med Rehab."},{"key":"B34","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1136\/bjsm.2002.003335","article-title":"Effect of tai chi exercise on proprioception of ankle and knee joints in old people","volume":"38","author":"Xu","year":"2004","journal-title":"Brit J Sport Med."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1016\/j.jelekin.2013.08.011","article-title":"Neuromuscular strategies for lumbopelvic control during frontal and sagittal plane movement challenges differ between people with and without low back pain","volume":"23","author":"Nelson-Wong","year":"2013","journal-title":"J Electromyogr Kinesiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1123\/jsr.19.4.422","article-title":"The relationship between hip-abductor strength and the magnitude of pelvic drop in patients with low back pain","volume":"19","author":"Kendall","year":"2010","journal-title":"J Sport Rehabil."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1016\/j.apmr.2011.02.015","article-title":"Sex differences in lumbopelvic movement patterns during hip medial rotation in people with chronic low back pain","volume":"92","author":"Hoffman","year":"2011","journal-title":"Arch Phys Med Rehab."},{"key":"B38","doi-asserted-by":"publisher","first-page":"227","DOI":"10.2522\/ptj.20160246","article-title":"Effectiveness of tai chi for chronic musculoskeletal pain conditions: updated systematic review and meta-analysis","volume":"97","author":"Hall","year":"2017","journal-title":"Phys Ther."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.952346\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T10:21:53Z","timestamp":1662546113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.952346\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,6]]},"references-count":38,"alternative-id":["10.3389\/fneur.2022.952346"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2022.952346","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,6]]},"article-number":"952346"}}