{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:43:34Z","timestamp":1791326614389,"version":"4.3.1"},"reference-count":44,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T00:00:00Z","timestamp":1672185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Prince Sattam bin Abdulaziz University","award":["PSAU\/2023\/R\/1444"],"award-info":[{"award-number":["PSAU\/2023\/R\/1444"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Chronic non-specific low back pain (CNLBP) is the most common musculoskeletal problem. The purpose of this study was to investigate the effects of advanced physiotherapeutic exercise programs on imaging findings and inflammatory biomarkers in soccer players with CNLBP. In total, 60 CNLBP participants were divided into virtual reality exercise (VRE; n = 20), isokinetic exercise (IKE; n = 20), and conventional exercise (n = 20) groups. Pain intensity, imaging findings (muscle cross-sectional area (CSA) and muscle thickness), and changes in inflammatory biomarkers (CRP, TNF-\u03b1, IL-2, IL-4, and IL-6) were measured at baseline and after four weeks. After four weeks of intervention, there was a significant improvement (p = 0.001) in pain intensity for the VRE vs. IKE (0.7; CI 95% 0.38 to 1.07) and VRE vs. conventional (3.0 CI 95% 2.68 to 3.31) groups. The IKE group showed a greater number of significant changes in muscle CSA and muscle thickness than the other two groups (p &lt; 0.001). Moreover, the VRE group showed significant improvement in inflammatory biomarker measures compared with the other two groups (p &lt; 0.001). In CNLBP, virtual and isokinetic exercises had equal effects on reducing pain intensity. Isokinetic exercise is beneficial in increasing the muscle CSA and thickness, and virtual exercises are helpful for attenuating the inflammation process in soccer players with CNLBP.<\/jats:p>","DOI":"10.3390\/ijerph20010524","type":"journal-article","created":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T02:56:50Z","timestamp":1672282610000},"page":"524","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Effects of Virtual Reality Exercises versus Isokinetic Exercises in comparison with Conventional Exercises on the Imaging Findings and Inflammatory Biomarker Changes in Soccer Players with Non-Specific Low Back Pain: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"20","author":[{"given":"Gopal","family":"Nambi","sequence":"first","affiliation":[{"name":"Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3686-8074","authenticated-orcid":false,"given":"Mshari","family":"Alghadier","sequence":"additional","affiliation":[{"name":"Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8272-674X","authenticated-orcid":false,"given":"Faizan Zaffar","family":"Kashoo","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama R.","family":"Aldhafian","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naif A.","family":"Nwihadh","sequence":"additional","affiliation":[{"name":"King Fahad Medical City, Riyadh 11525, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0296-5274","authenticated-orcid":false,"given":"Ayman K.","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia"},{"name":"Department of Orthopedic, Faculty of Medicine for Girls, Al Azhar University, Cairo 11651, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Omar","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Faculty of Medicine for Girls, Al Azhar University, Cairo 11651, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tohamy G. T.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Faculty of Medicine for Girls, Al Azhar University, Cairo 11651, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8309-7829","authenticated-orcid":false,"given":"Mohamed Nagah Ahmed","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Faculty of Medicine for Girls, Al Azhar University, Cairo 11651, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan Fathy","family":"El Behairy","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Faculty of Medicine for Girls, Al Azhar University, Cairo 11651, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdehamid A.","family":"Attallah","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Faculty of Medicine for Girls, Al Azhar University, Cairo 11651, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Abdelgwad","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Orthopedic, Faculty of Medicine for Girls, Al Azhar University, Cairo 11651, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/rnj.249","article-title":"Head Injuries in Soccer","volume":"41","author":"Myrick","year":"2016","journal-title":"Rehabil. 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