Acute lumbar sprain (ALS) is a common cause of acute low back pain. Wrist–ankle acupuncture (WAA) and related regimens are widely used in China for pain relief, but their comparative efficacy remains controversial.
Objective
To evaluate the efficacy and safety of WAA and related therapeutic regimens for ALS using network meta-analysis (NMA) and conventional meta-analysis (CMA).
Methods
Major English and Chinese databases were searched from inception to August 30, 2025 for randomized controlled trials (RCTs) of adults with ALS treated by WAA-based regimens. An NMA and CMA were conducted. Outcomes included clinical efficacy, pain intensity score, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI), lumbar range of motion, inflammatory markers, and occurrence of adverse events. The risk of bias was evaluated using the Cochrane Collaboration criteria, and statistical significance was set at p < 0.05.
Results
A total of 14 trials involving 1384 participants were included, with subjects assigned to a WAA-based treatment group (TG) or to a control group (CG) receiving other interventions. Both NMA and CMA showed that WAA and its related regimens alleviated the symptoms and signs of ALS to varying degrees, with a low incidence of adverse events and additional reduction in circulating inflammatory markers. Based on cumulative ranking probabilities, WAA combined with medication (WAACWM) showed a trend toward being the highest-ranked intervention; however, no significant superiority was demonstrated between regimens.
Conclusion
WAA and related therapeutic regimens appear effective and safe for ALS. WAACWM may offer the greatest benefit. Further high-quality RCTs with direct comparisons are still needed to confirm these findings.
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