Advances in rehabilitation for bone and joint pain: a critical narrative review of evidence, gaps, and future directions

Abstract

Chronic bone and joint pain is highly prevalent, and rehabilitation is a core component of care. This critical narrative review uses a transparent, structured evidence-mapping approach to examine rehabilitation studies published from January 2021 to April 2026, integrate findings across intervention classes, and identify evidence gaps. Across the included evidence base, exercise therapy supports pain and functional outcomes in selected musculoskeletal conditions, although optimal dose and phenotype-specific matching remain uncertain. Manual therapy and physical modalities may provide short-term adjunctive symptom relief, but their effects are conditional on technique, context, and protocol. Digital rehabilitation and virtual-reality-based approaches can improve access and engagement, but functional and long-term benefits are heterogeneous. Low-load blood-flow-restriction training is promising where high external loads are not tolerated; safety, dose, and longer-term effectiveness require further study. Rather than implying a universal precision-rehabilitation model, we present phenotype-informed treatment matching as a research agenda. Key limitations include heterogeneity of populations, interventions, outcome measures, and follow-up, the selective nature of narrative synthesis, publication bias, and the absence of pooled quantitative estimates. Exercise remains a foundation of care, with adjuncts selected according to presentation, patient priorities, feasibility, and response to reassessment.