Longstanding treatment debate: SGH compares physiotherapy and TCM tuina for lower back pain

Singapore, 12 May 2026 – Which is a better treatment for lower back pain: physiotherapy, Traditional Chinese Medicine (TCM) tuina (推拿), or a combination of both?

To address the question, Singapore General Hospital (SGH) recruited 204 patients between March 2021 and January 2023 for a 3-arm study. They were randomly assigned to receive either six sessions of physiotherapy at the Hospital, six sessions of tuina by registered TCM physicians from the Academy of Chinese Medicine Singapore, or three sessions each of both treatments over two months. Each session lasted 20 to 30 minutes.

The research team found that patients in all three groups reported significant pain relief after two months. While this suggests that TCM tuina can be a reasonable option for chronic lower back pain, they caution that it is not superior to and should not replace physiotherapy, which remains a mainstay treatment.

“In Singapore and across Asia, many people with lower back pain seek tuina treatment with therapeutic effects from registered TCM practitioners. Some visit both physiotherapists and TCM physicians, hoping to get better faster. Until now, there was limited scientific evidence to prove whether TCM tuina actually works for back pain,” said Professor Celia Tan, Senior Principal Physiotherapist at SGH and principal investigator of the study.

After five months, important differences emerged. Patients who received physiotherapy – either alone or combined with TCM tuina – were significantly better at performing daily activities like walking, sitting, and lifting compared to those who received only TCM tuina. This could be because exercises are usually taught during physiotherapy sessions so that patients can better manage their back pain at home. The combination treatment also provided better overall quality of life than TCM tuina alone.

This is the first study in Singapore that directly compared a TCM treatment with physiotherapy. It was funded by The HEAD Foundation, which also supported parallel research conducted at Mayo Clinic in the USA and Jinan University’s School of TCM in Guangzhou, China. Combined results from the three centres are being analysed for a comprehensive view of chronic lower back pain treatments from different populations and countries.

“The HEAD Foundation is excited to be part of a multi-centre research collaboration among the top medical centres in the world to promote integration of good medical practices from the East and the West so that they can complement each other in providing more holistic healthcare solutions,” said Mr Ho Swee Huat, Chairman of The HEAD Foundation Board of Directors.   

Lower back pain is a leading cause of disability worldwide, and 80 per cent of adults experience lower back pain at some point in their lives. While most of them will recover eventually even without treatment, some may suffer a relapse, and develop chronic lower back pain with symptoms lasting more than 12 weeks for reasons unknown.

“The study was developed based on the best practices of TCM and Western medicine practices, and the aim was to find synergies between the two to improve healthcare outcomes for our patients,” said Professor Tay Boon Keng, Emeritus Consultant, Department of Orthopaedic Surgery, SGH, who is also the co-investigator of the trial. 

Looking ahead, SGH plans to expand its research into other potential applications of TCM tuina therapy, including shoulder and knee pain, as well as neurological conditions such as insomnia.

The study results (doi: 10.1186/s12906-025-05234-w.) were published in January 2026 in BMC Complementary Medicine and Therapies, a peer-reviewed, open-access journal that publishes original research on complementary and alternative medicine.