Chinese exercises and chronic low back pain: do Tai Chi and Baduanjin reduce pain and disability? What the studies say and how long the benefits last.
What are traditional Chinese exercises
“Traditional Chinese exercises” refers to a group of body practices that originated in China, combining slow, controlled movements, held postures, breathing and concentration. The best known in Italy is Tai Chi, but there are others:
- Tai Chi, a continuous sequence of slow movements, which originated as a martial art;
- Baduanjin, also called the “eight pieces of brocade”, a series of eight standing exercises that is easy to learn;
- Yijinjing, a series of exercises with stretches and held contractions, traditionally intended to “strengthen the tendons”;
- Wuqinxi, the “five animals play”, in which the movements imitate the tiger, deer, bear, monkey and bird.
They share two features that make them interesting for people with low back pain: the intensity is low, so they are suitable even for people who are out of shape, and they can be practised in a group or at home, without equipment.
Why it is being discussed now
Chronic low back pain, meaning pain that lasts more than three months, has for decades been the leading cause of disability worldwide. Guidelines recommend exercise as the first treatment, but leave a practical question open: which exercise? There are now many studies on Chinese exercises, but until now a direct comparison of the different practices was missing. This review attempts to fill the gap with a statistical method, network meta-analysis, which makes it possible to compare treatments with one another even when they have never been compared in the same study.
How the study was conducted
The authors searched seven databases, as well as the so-called grey literature (theses, conference proceedings, registries), for randomised studies of traditional Chinese exercises in adults with chronic low back pain, up to 2 August 2026. They included 43, on the four practices described above, used alone or together with “conventional therapy”.
They then measured three outcomes:
- pain, on the visual analogue scale (VAS), the one on which the patient marks the intensity on a line from “no pain” to “the worst pain imaginable”;
- disability, with the Oswestry Disability Index (ODI), a questionnaire on how much low back pain limits everyday activities;
- function of the lumbar spine, with the Japanese Orthopaedic Association (JOA) score.
The quality of the studies and the certainty of the evidence were assessed with standard risk-of-bias tools and with the CINeMA method, designed specifically for network meta-analyses.
The results: effectiveness of Chinese exercises on chronic low back pain
Pain
The most important finding is also the one least mentioned in headlines: the reduction in pain was significant only when the Chinese exercise was added to conventional therapy. The exercises practised alone did not show a significant reduction in pain. Among the combinations, the numerically largest benefit was that of Yijinjing plus conventional therapy, followed by Tai Chi and Baduanjin, again together with conventional therapy.
Disability and back function
On disability measured with the Oswestry index, the people who practised Baduanjin and Wuqinxi improved significantly, both combined with conventional therapy. On lumbar function (JOA score), people improved with Baduanjin, Wuqinxi and Yijinjing, once again in combination with conventional therapy.
Is there one exercise that is better than the others?
No, at least for now. The statistical rankings put Yijinjing first for pain and Wuqinxi first for function, but direct comparisons between the effective combinations showed no significant differences. As a result, as the authors themselves write, it is not possible to establish which practice is superior. The certainty of the evidence was judged low to moderate for all outcomes.
How to read these results
The authors describe “large” effects of the combinations. This statement should be taken with caution, for three reasons.
The first is the low or moderate certainty of the evidence: it means that future studies could substantially change the estimate of the effect. The second is that in exercise studies the patient always knows which treatment they are receiving, and this alone can improve the pain they report; it is no coincidence that, in the Cochrane review on exercise for chronic low back pain, almost eight studies out of ten were at risk of this type of bias. The third concerns “conventional therapy”: the abstract does not make clear what it consisted of (drugs, physiotherapy, other), so it is not known exactly what the Chinese exercises were added to.
The result that remains solid is a different one: adding an exercise of this kind to usual care improves pain and function more than usual care alone. This is consistent with what we already know about exercise in general.
What we already knew: exercise in chronic low back pain
Chinese exercises do not come out of nowhere. The 2021 Cochrane review, which brought together 249 randomised studies, concluded with moderate certainty that exercise reduces the pain of chronic low back pain compared with no treatment, usual care or placebo, by about 15 points out of 100: a difference that patients notice. The effect on disability, on the other hand, was small.
On Tai Chi in particular, a randomised study conducted in Sydney on 160 adults with persistent low back pain compared 18 group sessions of 40 minutes, over 10 weeks, with usual care alone. Pain fell by 1.3 points on a 0 to 10 scale and disability by 2.6 points on a 0 to 24 scale, a benefit that researchers and participants judged worthwhile.
As early as 2017, the American College of Physicians guideline recommended, for chronic low back pain, starting with non-drug treatments: exercise, multidisciplinary rehabilitation, acupuncture, mindfulness and, with lower-quality evidence, also Tai Chi and yoga. Drugs, starting with anti-inflammatories, come afterwards, if these treatments are not enough.
What it means for patients
In my pain therapy clinic, chronic low back pain is one of the most frequent reasons for a visit, and one of the biggest difficulties is not finding the right exercise, but finding one that the patient keeps doing. That is why I consider the most useful result of this review to be precisely the absence of a winner: Tai Chi, Baduanjin, Yijinjing and Wuqinxi appear to be equivalent, and you can choose the one you like most or the one that is easiest to practise near home. From personal experience, other useful exercises are yoga and postural exercise, which often cannot improve low back pain, but manage to maintain the effectiveness of the treatments received over time, reducing the number of visits to our medical centre for further treatment over time.
A few practical points:
- Chinese exercises are added to treatment, they do not replace it: the benefit on pain emerged only in combination with conventional therapy;
- diagnosis first: low back pain that has lasted for months should be assessed by a doctor, to rule out specific causes, such as a lumbar disc herniation, that require a different approach;
- consistency matters: in the Australian study the benefit came after 10 weeks of regular practice;
- they are also suitable for older people or people who are not very fit, because the intensity is low (see also our article on physical activity in older people).
Often the pain does not improve with exercise and basic treatment; in that case an assessment at a pain therapy centre is needed, which makes it possible to build a more complete care plan.
Message for doctors
The review includes 43 randomised studies and confirms that traditional Chinese exercises, added to conventional therapy, improve pain, disability and lumbar function in chronic low back pain, with low or moderate certainty. On their own they did not reduce pain significantly, and no practice proved superior to the others in direct comparisons. In practice they can be offered as one of the forms of exercise recommended by guidelines, choosing according to the patient’s preferences and the availability of classes, as the authors themselves suggest, and without presenting them as an alternative to treatment.
References
- Zhang H, Liu L, Wu Q, Yan Y, Kou J, Du C. Efficacy of Traditional Chinese Exercises on Chronic Low Back Pain: A Systematic Review and Network Meta-analysis. Complementary Therapies in Medicine. 2026:103458 (published online ahead of print). doi:10.1016/j.ctim.2026.103458. PubMed
- Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews. 2021;9(9):CD009790. doi:10.1002/14651858.CD009790.pub2. PubMed
- Hall AM, Maher CG, Lam P, Ferreira M, Latimer J. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care & Research. 2011;63(11):1576-1583. doi:10.1002/acr.20594. PubMed
- Qaseem A, Wilt TJ, McLean RM, Forciea MA, Denberg TD, Barry MJ, Boyd C, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530. doi:10.7326/M16-2367. PubMed
Dr. Marco De Nardin
Medical Doctor, Specialist in Anesthesiology, Intensive Care and Pain Management
Dr. Marco De Nardin is a physician specializing in Anesthesiology, Intensive Care, and Pain Management. He completed his medical degree and specialty training in Italy, where he continues to practice at his private clinics in Mestre (Venice) and Milan. With extensive clinical experience spanning operating rooms, intensive care units, and pain management clinics, Dr. De Nardin brings a unique perspective that bridges acute-care medicine with chronic disease management. His clinical practice focuses on regional anesthesia, ozone therapy, intravenous infusion therapy, and integrative approaches to pain treatment. He is the founder of Med4Care, a medical information platform delivering evidence-based, physician-reviewed health content. Every article published under his name reflects his commitment to making complex medical topics accessible to patients without compromising scientific rigor.
