Evaluating the Efficacy of Biofeedback in Pain Management and Rehabilitation of Sports Injuries: A Systematic Review
Andrei Mateus Delgado Viana1, Neha Pirwani2,3, Attila Szabo4
1Doctoral School of Psychology, Department of Affective Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
Abstract:
To evaluate the effectiveness of biofeedback interventions for pain management and rehabilitation outcomes in athletes and individuals with sports-related injuries. Systematic review of randomized controlled trials. A systematic literature search was conducted in eight electronic databases: PubMed, Google Scholar, Web of Science, Scopus, ProQuest, PEDro, SPORTDiscus, and the Cochrane Central Register of Controlled Trials. Searches were completed in September 2024 and updated in November 2025. Randomized controlled trials investigating the use of biofeedback interventions for pain management and rehabilitation in athletes or individuals with sports-related injuries were eligible for inclusion. Due to heterogeneity in participant characteristics, injury types, biofeedback modalities, and outcome measures, a narrative synthesis was performed. Methodological quality was assessed using the Cochrane Risk of Bias tool. Nine randomized controlled trials from Saudi Arabia, Taiwan, Canada, Romania, Brazil, and Iran were included. Biofeedback interventions addressed patellofemoral pain, shoulder impingement, chronic ankle instability, plantar fasciitis, post-traumatic osteoarthritis, chronic low back pain, meniscal injuries, and other musculoskeletal sports injuries. Modalities included electromyography, heart rate variability, neurofeedback, virtual reality feedback, and real-time visual gait retraining. Biofeedback was associated with reduced pain, improved muscle activation and strength, enhanced functional recovery, and better rehabilitation outcomes. Biofeedback may be a valuable adjunct to conventional rehabilitation for athletes or individuals with sports-related injuries. For clinicians, it can enhance neuromuscular control, patient engagement, and functional outcomes in multimodal programs. However, the certainty of the evidence is low, and further high-quality trials across diverse populations are needed.