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Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation

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Does Treating Low Back Pain With Therapeutic Exercise Reduce the Risk of Subsequent Lower Extremity Injury? A

Kaitlyn Foster^1,2,3, Sharon Wang-Price², Mark Weber²

¹Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio, TX 78234, United States.

Physical Therapy

|November 15, 2025

Summary

Therapeutic exercise for low back pain significantly reduces the risk of subsequent lower extremity injuries in military personnel. More exercise sessions further decrease injury risk, potentially lowering healthcare costs.

Keywords:

Anatomy: Lower Extremity Back Injuries Musculoskeletal Pain Orthopedics Physical Therapists Risk Factors

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Area of Science:

Military medicine
Orthopedics
Physical therapy

Background:

The trunk and lower extremities are common sites of military injury, often managed separately.
This study investigates the connection between low back pain and lower extremity injuries.

Purpose of the Study:

To determine if therapeutic exercise for low back pain decreases the risk of subsequent lower extremity injuries.
To explore the dose-response relationship between exercise sessions and injury risk.

Main Methods:

Longitudinal cohort study using Military Health System data (January 2015-July 2019).
Included 452,668 patients aged 18-65 with low back pain diagnoses.
Cox proportional hazards regression analyzed the association between therapeutic exercise and hip, knee, and ankle/foot injuries.

Main Results:

Therapeutic exercise receipt (74,912 participants) significantly reduced lower extremity injury risk (hip: HR 0.84, knee: HR 0.77, ankle/foot: HR 0.80).
Increased exercise sessions correlated with further risk reduction (hip: HR 0.95, knee: HR 0.96, ankle/foot: HR 0.96 per session).

Conclusions:

Low back pain patients not receiving therapeutic exercise face higher risks of subsequent lower extremity injury.
Therapeutic exercise is protective, with benefits increasing with more sessions.
Implementing therapeutic exercise for low back pain may reduce the overall healthcare burden.