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Open research questions in Musculoskeletal pain and rehabilitation

131 unresolved questions extracted from the limitations and future-work sections of 1,607 Musculoskeletal pain and rehabilitation papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Implement comprehensive injury prevention strategies, including proper training on body mechanics, ergonomic workstations, and the availability of appropriate equipment to reduce physical demands on physical therapists. Encourage regular rest breaks, particularly for those performing manual therapy, responding to sudden patient movements, or working in prolonged static postures. Promote a culture of self-care and early intervention, where physical therapists are encouraged to stop working and seek appropriate medical attention when experiencing symptoms of muscle strain or fatigue. Develop age-specific and experience-specific interventions and workplace adjustments to address the unique risks and challenges faced by physical therapists at different stages of their careers. Implement flexible work arrangements, such as adjustable work schedules and workday frequencies, to accommodate the physical demands of the profession while ensuring the well-being of practitioners.

    Prevalence, Cause, and Prevention of Muscle Strain and Fatigue among Physical Therapists in Al Zawiya City: A Cross-sectional Study · 2026 · DOI
  • clinical outcomes.29 Financial class has been studied in relation to the utilization of visits to physical therapy.19 This study analyzed insurance type with respect to clinical outcomes of NSLBP. Our findings report that individuals on Medicaid (HMO) seemed to have negative outcomes in PT. This has been supported in a study that reported that poor health outcomes have been linked to being socioeconomically poor.46 Thus, the current study found an association between demographic factors like BMI, marital status and insurance type and clinical outcomes of NSLBP in patients receiving PT.

    Factors Impacting Physical Therapy Clinical Outcomes for Patients with Low Back Pain: A Retrospective Analysis · 2026 · DOI
  • Regarding muscle activity, significant group effects were limited to the left IC during the hip-height load-holding task and the near- full trunk flexion task, and to the right EO during the head-height load- holding task, with mean activation levels remaining below 20% MVC for all muscles.

    A partially personalized musculoskeletal spine model using MRI and EMG data to compare biomechanics of asymptomatic and low back pain individuals · 2026 · DOI
  • Given that minimal detect- able change (MDC) and minimal clinically important difference (MCID) values for the K-10 have not been established, it is difficult to determine whether these indi- vidual changes represent clinically meaningful changes in psychological distress or normal fluctuations over time.

    A reduction in perceived psychological distress over three years is associated with improvements in pain and symptoms in patients with longstanding hip and groin pain - a longitudinal prospective cohort study · 2026 · DOI
  • We acknowledge that CVA alone is insufficient to accurately classify individuals with and without NSNP, and the low predictive performance observed in this study was expected given the complexity of the condition.

    The cervicovertebral angle as an associated factor of neck pain in female manufacturing workers: a dual-model cutoff analysis using logistic regression and decision trees · 2026 · DOI
  • Despite this study has several limitations that should be acknowledged. First, the absence of a control group receiving only conventional physiotherapy without any taping intervention limits the ability to isolate the specific additive effect of taping from the overall treatment program. Second, our outcomes relied exclusively on lack of objective participant­reported measures; assessments, such as muscle strength (e.g., using a dynamometer) or cervical range of motion, was due to technical equipment constraints. Third, the relatively short follow­up period prevents the assessment of the long­term sustainability of the observed improvements. Furthermore, the sample size, while meeting the minimum power requirement, may restrict the generalizability of the findings to broader populations. Lastly, the limited diversity in the demographic and clinical characteristics of the participants further constrains the applicability of the results. Future research incorporating larger cohorts, objective measurement tools, and long­term follow­up is necessary to provide a more comprehensive understanding of the therapeutic role of Kinesio Taping. Second, our outcomes relied exclusively on participant­ reported measures; the lack of objective assessments, such as muscle strength (e.g., using a dynamometer) or cervical range of motion, was due to technical equipment constraints. Third, the relatively short follow­up period prevents the assessment of the long­term sustainability of the observed improvements. Furthermore, the sample size, while meeting the minimum power requirement, may restrict the generalizability of the nr 1/2026 (26) the findings to broader populations. Lastly, the limited diversity in the demographic and clinical characteristics of the participants further constrains the applicability of the results. Future research incorporating larger cohorts, objective measurement tools, and long­term follow­up is necessary to provide a more comprehensive understanding of the therapeutic role of Kinesio Taping. Our study possesses several methodological strengths that enhance the validity of its findings. First, the inclusion of participants across various age groups and pain severity levels allows for a broader evaluation of Kinesio Taping (KT) effects across a clinically diverse population. The participant­ and assessor­blinded, randomized controlled design significantly minimized potential selection and observation biases, while thereby ensuring baseline homogeneity between groups, increasing results. the comparative reliability of Furthermore, the use of validated and reliable assessment tools (VAS, FreNAQ, and NBQ) ensured high objectivity in evaluating pain, neck awareness, and functional status. The standardization of the KT protocols and conventional physiotherapy interventions, both of which are described in detail, enhances the reproducibility of the study and its direct applicability to clinical practice. Finally, the strict adherence to blinded research methodology throughout both the assessment and treatment phases strengthened the study’s internal validity, supporting the overall credibility and accuracy of the results. Overall, exercise therapy and comprehensive physiotherapy should be considered the cornerstone of chronic neck pain management, while kinesiotaping should be used only as an adjunctive intervention. Furthermore, since real KT did not provide a significant clinical advantage over sham KT, its routine use in clinical practice may not be economically justified considering the additional costs of materials and the time required for application. However, KT may still be considered as a complementary option for patients who prefer it or to benefit from its potential psychological (placebo) effects, provided it does not replace core evidence­based treatments.

    The effects of kinesio taping applications on pain, neck awareness, and functionality in neck pain: a randomized clinical trial · 2026 · DOI
  • The limitations of this study include the small sample size, large age differences, and significant heterogeneity, which impacted the power of statistical tests. It would also be worthwhile to include individuals from diverse backgrounds and extend the intervention and observation periods.

    Assessment of the impact of physiotherapy on the perception of pain, fatigue levels and functional status in patients with multiple sclerosis · 2026 · DOI
  • This study has several limitations that should be considered when interpreting the results. First, the follow-up period was only 3 months. Future research with longer follow-up times is needed to assess whether the differences in the FCSA of the multifidus are maintained or even out over time. Second, although assessing the FCSA of the multifidus with MRI is a validated way to measure muscle health, it does not directly reflect muscle strength, endurance, or activation patterns, all of which are important for spine health. Therefore, while our results show structural changes, the relationship between these changes and functional recovery remains indirect. Third, because a minimally important change in multifidus FCSA has not been established for this population, the statistically significant between-group difference does not necessarily indicate that the 8% difference observed is clinically meaningful. Future research is needed to determine the clinical relevance of this magnitude of change. Finally, this was a secondary analysis of a larger trial that was not originally powered to detect differences in lumbar multifidus morphology. As a result, the study may have been underpowered to detect smaller between-group differences, particularly for secondary outcomes such as the erector spinae. These findings should therefore be interpreted with appropriate caution and confirmed in future studies specifically powered for muscle morphology outcomes.

    Timing of Physical Therapy and Lumbar Muscle Atrophy in Adolescent Athletes With Spondylolysis · 2026 · DOI
  • Although previous studies have reported reduced strength in the abdominal and back muscles among individuals with LI, respiratory muscle, which plays a crucial role in spinal stability, remains largely unexplored in this population and has not been compared across patients with chronic low back pain (CLBP) and healthy individuals.

    Respiratory muscle strength and endurance in individuals with and without lumbar instability: a cross-sectional study · 2026 · DOI
  • Although clinical guidelines recommend active strategies combining multicomponent exercise and Pain Neuroscience Education (PNE), robust geriatric evidence remains scarce.

    Efficacy of Pain Neuroscience Education Combined with Exercise in Older Adults with Chronic Pain: Study Protocol for a Randomized Controlled Trial · 2026 · DOI
  • While Progressive Muscle Relaxation (PMR) is widely used for stress reduction, the potential additive benefits of physiotherapy-led postural exercises on psychological and biological markers of distress remain unexplored.

    Effect of Postural Exercises on Physiological and Biological Markers of Perceived Distress among Undergraduate Health Professionals Students: A Research Protocol for Randomised Controlled Trial · 2026 · DOI
  • Single-group pre-post study design without a control group. Relatively small sample size. Short-term follow- IJDDT, Volume 16 Issue 51s, 2026 Page: 1842 Effectiveness of a Renewal-Based Biopsychosocial Rehabilitation Approach Incorporating Active Release Technique (ART) in Individuals with Chronic Neck Pain: A Prospective Interventional Study for study cohort prospective biomedicine. 8. Turk DC, Fillingim RB, Ohrbach R, Patel KV. Assessment of psychosocial and functional impact of chronic pain. J Pain. 2016;17(9 Suppl):T21-T49. 9. Engel GL. The need for a new medical model: a challenge Science. 1977;196(4286):129-136. 10. Gatchel RJ, Peng YB, Peters ML, et al. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624. 11. Letzel J, Angst F, Weigl MB. Multidisciplinary biopsychosocial rehabilitation in chronic neck pain: a naturalistic with intraindividual control of effects. Eur J Phys Rehabil Med. 2019;55(6):727-735. 12. Choudhry NK, et al. Effect of a biopsychosocial intervention or postural therapy on pain-related disability in patients with acute and subacute spine pain. JAMA Netw Open. 2022;5(3):e221770. 13. Kim JH, Lee HS, Park SW. Effectiveness of Active Release Technique on pain and range of motion in patients with chronic neck pain. J Phys Ther Sci. 2020;32(2):145-150. 14. Hammer WI. Functional soft-tissue examination and treatment by manual methods. 3rd ed. Jones & Bartlett Learning; 2007. 15. Farrar JT, Young JP Jr, LaMoreaux L, et al.

    Effectiveness of a Renewal-Based Biopsychosocial Rehabilitation Approach Incorporating Active Release Technique (ART) in Individuals with Chronic Neck Pain: A Prospective Interventional Study · 2026 · DOI
  • This study examines a psychoeducational intervention uti- lizing MBSR body scan training for individuals with CLBP in AR. The findings indicate that pain intensity and pain- related variables can be reduced about both groups without any significant differences between the IG and the CG, with the interaction of group x time serving as the primary test. The limitations of this study are as follows: (1) Since we conducted a pilot study, a primary limitation of this study is the small sample size, which constrained the statistical power. Consequently, differences between the groups may not have been identified, and pertinent effects may have remained undetected. (2) Given the exploratory nature of this pilot study, the findings cannot be generalized to a clini- cal population with moderate or severe CLBP. Nonetheless, they establish a basis for subsequent research on AR inter- ventions in patients with significant pain intensity and func- tional limitations, as these cohorts may derive the greatest benefit. The exclusion of participants with severe psychiat- ric disorders and the absence of a systematic evaluation of comorbid mental disorders in our study necessitate further research. Integrating the intervention into existing clinical care frameworks, such as pain management programs in rehabilitation settings, would be advantageous for explor- ing differential effects based on pain severity and evalu- ating its potential applicability in randomized controlled trials. (3) The mechanisms of action of psychoeducation and body scan on the outcomes cannot be distinguished from one another. Future studies could aim to disentangle the confounding mechanisms. (4) Another limitation is the lack of baseline data regarding the use of analgesics and psychotropic medications, which complicates the compari- son of our results with those of other studies. In the context of CLBP, psychosocial factors contribute to the persistence of pain, and it remains uncertain how psychotropic medi- cations or analgesics may have influenced the participants' motivation or study outcomes. (5) A significant challenge is the practical implementation of AR-based interventions. AR and VR technologies are currently expensive and not extensively integrated into routine clinical practice, thereby limiting their applicability. Future research should prioritize the development of more accessible and cost-effective for- mats that incorporate AR and VR elements, such as smart- phone applications and gaming headsets, to enhance their feasibility beyond research environments. (6) An additional limitation is the uneven gender distribution within the sam- ple, which may have influenced the generalizability of the findings concerning gender-specific differences in coping strategies and the utilization of digital interventions. (7) The potential effects of the wide age range of participants (21– 67 years) on both participation and the outcomes of the AR intervention were not examined. Consequently, the results should be interpreted with caution, as it remains uncertain whether age-related differences, such as prior experience with digital technologies, age-specific coping strategies, and age-related comorbid functional limitations, may have influenced the AR intervention. These factors should be considered potential moderators in future studies. (8) Future research should integrate qualitative methodologies, such as interviews or focus groups, to more effectively capture par- ticipants' experiences and support the further development of AR interventions.

    Piloting of Augmented Reality-Based Psychoeducation with Mindfulness Intervention for Chronic Low Back Pain · 2026 · DOI
  • Strengths of the study include the steps that we ap- plied to foster inclusion. We wanted to recruit people who may not have otherwise put themselves forwards 11 for research involvement, hoping to counter the epis- temic injustice (silencing) that can occur, and to con- tribute to improved participation in research. The strength of the dual role of clinician-researcher should also be recognised here in identifying the need for the study topic, providing insights into participation/inclu- sion and in recruitment. Limitations of the study are mostly due to the nature of the cohort and the recruitment; a higher number of participants may have given a more diverse range of perspectives and insights. The study was not designed to achieve data saturation; rather, purposive sampling was used to recruit participants with specific, relevant lived experiences, consistent with qualitative ap- proaches prioritising depth and contextual specificity over breadth, for example, Smith et al.13. We did not aim for the cohort to be representative of all with chronic pain, or who may experience marginalisation within an intersectional framing. We had limited per- spectives of current caring responsibilities and those at paid work – many at work may struggle to make ends meet and have difficulty even attending for healthcare appointments.73 All participants identified as straight and cis-gender, and we gained limited understanding of racialised marginalisation. The ‘ecosystem’ concept is contextual and should be expected to vary across groups of people, and the research here was explora- tory in nature. We only involved four GP colleagues in recruitment who had limited time to raise potential study participa- tion with patients. Another factor that potentially lim- ited recruitment was the time commitment and lack of flexibility regarding the days and location of the study. In future we could improve flexibility by conducting a one-off focus group or world café in different locations.

    An ecosystem of living with severe, long-term pain – the role of (un)accepting systems: a qualitative study · 2026 · DOI
  • This study did not specifically examine the underlying causes of CNP, which limits the evaluation of effects across different subtypes. The intervention duration was limited to 6 weeks, so long-term effects were not assessed. Addition- ally, only pain and functionality outcomes were analyzed. Medical co-morbidities, pain-related symptoms such as numbness, burning, tingling, as well as sensory abnormali- ties including hyperalgesia and allodynia, were not evalu- ated, which could have influenced the treatment outcomes. Moreover, the total duration of therapy differed between the two groups, which may have impacted the observed effects over the study period. Future studies are recommended to address these points.

    Examining the Effects of Core Stabilization Exercises and Myofascial Release Technique in Individuals with Chronic Neck Pain: A Randomized Clinical Trial · 2026 · DOI
  • This study has several limitations. First, notable clinical and methodological heterogeneity existed across included trials, with dif- ferences in population characteristics, baseline pain levels, and research settings, which may reduce the stability of pooled effect estimates. Second, substantial variation in intervention content and imple- mentation was observed across exercise protocols, which may limit the comparability and reproducibility of the dose−response findings. Third, several included trials had unclear or high risk of bias in randomization, allocation concealment, or blinding, which may lower the overall certainty of evidence. Fourth, SUCRA rankings reflect relative probabilistic efficacy rather than definitive clinical superiority, and thus require cautious interpretation to avoid overstatement of between−interven- tion differences. Finally, existing literature provides scarce data on exercise intensity, limiting a deeper exploration of dose-response relation- ships. Subsequent studies should include more trials with standard- ized intensity metrics to address this gap.

    Comparative effects of exercise modalities and dose parameters on chronic low back pain in adults: a systematic review and network meta-analysis · 2026 · DOI
  • • Provide counseling, time management workshops, and career guidance to support students in higher academic years. • Create intervention programs that are specific to the stressors of the junior and senior students and are yearspecific. • Implement organized orientation and mentorship programs that can assist first and second-year students to cope with the academic demands. • Longitudinal research will help to monitor the changes in student stress throughout the period and assess the effectiveness of the interventions carried out REFERENCES Agatha, S., Thanaya, S. A. P., Sundari, L. P. R., & Nugraha, M. H. S. (2022). Overview of musculoskeletal disorders in undergraduate students. Physical Therapy Journal of Indonesia, 3(2), 49-53. A. M. Tami., E. C. Bika Lele., J. Mekoulou Ndongo., C. N. Ayina Ayina., W. R. Guessogo., M. Y. Lobe Tanga., L. J. Owona Manga., A. Temfemo., B. Bongue., S. H. Mandengue., N. Barth., & P. B. Assomo Ndemba. (2021). Epidemiology of musculoskeletal disorders among the teaching staff of the University of Douala, Cameroon: Association with physical activity practice. International Journal of Environmental Research and Public Health, 18(11), 6004. https://doi.org/10.3390/ ijerph18116004 Ahmed, H., Saeed, M. A., & Attique, F. (2024). The burden of musculoskeletal pain, associated sociodemographic factors, and disability in Pakistan. International Journal of Rheumatic Diseases, 27(1), e14972. Alturkistani, L. H., Hendi, O. M., Bajaber, A. S., Alhamoud, M. A., Althobaiti, S. S., Alharthi, T. A., & Atallah, A. A. (2020). Prevalence of Lower Back Pain 0 5 https://journals.e-palli.com/home/index.php/ajpehs Page Am. J. Phys. Educ. Health Sci. 4(1) 39-52, 2026 and its Relation to Stress Among Medical Students in Taif University, Saudi Arabia. International journal of preventive medicine, 11(1). https://journals.lww.com/ ijom/fulltext/2020/11000/prevalence_of_lower_ back_pain_and_its_relation_to.35.aspx Bonfiglioli, R., Caraballo-Arias, Y., & Salmen-Navarro, A. (2022). Epidemiology of work-related musculoskeletal disorders. Current Opinion in Epidemiology and Public Health, 1(1), 18-24. B. Morais., G. Dalmolin., C. Pedro., J. Bresolin., R. Andolhe., & T. Magnago. (2021). Perceived stress and musculoskeletal pain among undergraduate health students. Texto & Contexto – Enfermagem, 30, e20200076. https://doi.org/10.1590/1980-265x-tce-2020-0076 Cao, M., Sheng, R., Sun, Y., Cao, Y., Wang, H., Zhang, M., Pu, Y., Gao, Y., Zhang, Y., Lu, P., Teng, G., Wang, Q., & Rui, Y. (2024). Delivering Microrobots in the Musculoskeletal System. Nanomicro Lett, 16(1), 251. https://doi.org/10.1007/s40820-024-01464-8 Coglianese, D. (2024). Individuals With Localized Musculoskeletal and Connective Tissue Disorders.

    Association between Musculoskeletal Problems, Physical Activity, and Perceived Stress among Undergraduate Physical Therapy Students: A Cross-Sectional Study · 2026 · DOI
  • • The cross-sectional design captures stress at a single point in time and cannot establish causality. • Some students required additional explanation of the questionnaire items, which could have influenced their understanding and responses. • Potential confounding factors such as socioeconomic background, personal health, and family support systems were not controlled. that indicated CONCLUSION The cross-tabulation analysis the relationship between the categories of SSI and the year of study is statistically significant (p = 0.040). Most of the students fell in the moderate range of stress (61-90), especially in lower years, but students in the later years showed a relatively higher variance in lower and higher SSI range. These results show that the level of stress is not equally distributed but it changes as the course of academic advancement, which highlights the role of academic pressures during a particular year.

    Association between Musculoskeletal Problems, Physical Activity, and Perceived Stress among Undergraduate Physical Therapy Students: A Cross-Sectional Study · 2026 · DOI
  • Data availability statement This meta-analysis presents certain constraints that warrant attention. Primarily, the majority of incorporated investigations featured limited participant numbers, which may distort treatment evaluations and inflate the perceived effectiveness of TSM. Additionally, substantial variation existed in the illness duration of enrolled participants across different ran- domized controlled trials, leading to notable discrepancies in short-term outcomes among neck pain patients receiving TSM therapy. Moreover, the selected RCTs predominantly focused on assessing TSM’s immediate therapeutic benefits for neck pain sufferers, with insufficient extended monitoring data to evaluate its sustained effects. Finally, due to the limited number of currently included studies with small sample sizes, we were unable to conduct subgroup analyses across more dimensions The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author.

    The immediate effects of thoracic spine manipulation in patients with neck pain: a meta-analysis of randomized controlled trials · 2026 · DOI
  • Background While there is evidence supporting the potential of alpha-lipoic acid (ALA) to improve nerve conduction parameters in certain neurological conditions, particularly diabetic neuropathy, its specific effects on nerve conduction in chronic low back pain (CLBP) patients have not been directly addressed in the current context.

    HUBER PROPRIOCEPTIVE TRAINING AND ALPHALIPOIC ACID: A NEW APPROACH IN OPTIMIZING NERVE FUNCTION IN PATIENTS WITH CHRONIC LOW BACK PAIN · 2025 · DOI
  • As evidence-based recommendations of regular trunk muscle training to prevent LBP in nurses remains unclear, this pilot study sought 1) to ascertain the feasibility of machine-based trunk muscle strengthening at the workplace to prevent LBP and disability and 2) to identify suitable and sensitive health and functional measures to be included in a confirmatory RCT.

    MACHINE BASED TRUNK MUSCLE STRENGTHENING IN THE PREVENTION OF LOW BACK PAIN IN ACTIVE NURSES AGED 45+: RESULTS OF A FEASIBILITY RANDOMIZED CONTROLLED STUDY · 2025 · DOI
  • The study found no statistical differences in several sociodemographic variables (age, marital status, type of occupation, schooling, work hours, and degree of obesity) in relation to prolonged disability duration, suggesting the need for further investigation into why these expected factors showed no significant association.

    Association of Sociodemographic Factors and Prolonged Recovery Time from Work Disability in Patients with Cervical Sprain in Obregon City, Mexico · 2022 · DOI
  • Background: Prospective studies on the effects of progressive goal attainment programme (PGAP) on treatment outcomes and specifically psychosocial variables in individuals with non-specific low back pain (NSLBP) are scarce.

    Augmenting conventional treatment of non-specific low back pain with progressive goal attainment programme · 2018 · DOI
  • Given that work strains is a main risk factor for LBP development, recovery in leisure time seems to be a highly relevant aspect, which has not been investigated to date in the field of LBP.

    The influences of recovery on low back pain development: A theoretical model · 2015 · DOI
  • Research has indicated physical activity and exercise can effectively attenuate biopsychosocial osteoarthritis-related symptoms in adults, more so than other management strategies; however, both leisure and structured physical activity are scarcely recommended by health care providers, and remain rarely adopted and adhered to in this patient population.

    Painful Choices: A Qualitative Exploration of Facilitators and Barriers to Active Lifestyles Among Adults With Osteoarthritis · 2015 · DOI

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