Inflammatory Biomarkers in Low Back Pain: Physiological Insights and Implications for Exercise: A Narrative Review

Low back pain is a major cause of disability and is increasingly recognized as a multifactorial condition involving complex inflammatory and neuroimmune mechanisms. Inflammatory biomarkers may provide insight into the biological processes underlying pain persistence and may have potential value for patient stratification and treatment monitoring. This narrative review synthesizes current evidence on inflammatory biomarkers in low back pain and their potential pathophysiological relevance, with particular emphasis on the effects of exercise on inflammatory and neuroimmune responses. Literature searches were conducted in PubMed/MEDLINE and Google Scholar using combinations of terms related to low back pain, chronic low back pain, inflammatory biomarkers, cytokines, chemokines, neuroinflammation, sensitization, exercise, and physiotherapy, without publication-date restrictions. Relevant systematic reviews, meta-analyses, narrative reviews, observational studies, intervention studies, and selected mechanistic studies were considered based on their relevance to the review aims, methodological rigor, recency, and directness to low back pain populations. Among the most studied pro-inflammatory biomarkers are interleukins IL-1β, IL-6, IL-8, and IL-17; tumor necrosis factor-alpha (TNF-α); interferon-gamma (IFN-γ); C-reactive protein (CRP); and high-sensitivity C-reactive protein (hs-CRP). Commonly investigated anti-inflammatory cytokines include IL-4, IL-10, IL-13, and transforming growth factor-beta (TGF-β). Exercise is a cornerstone of conservative management for low back pain and may exert both pro- and anti-inflammatory effects, with responses depending on factors such as exercise type, intensity, duration, training status, and the tissues involved. However, the effects of exercise on inflammatory biomarkers in low back pain remain incompletely understood, and findings across studies are inconsistent. A better understanding of these relationships may provide insight into the biological effects of exercise and contribute to more individualized and biologically informed physiotherapy and exercise-based management of low back pain.