Analysis of the Mechanism of Exercise Interventions in Nurses with Chronic Non‑Specific Low Back Pain Based on the CoVIn Pathogenetic Model: A Scoping Review

Document Type : Review Articles

Authors
Seyed Sadredin Shojaedin 1
Mahdiyeh Mokhtari 2
Alireza Ebrahimi 2
1 Professor, Department of Biomechanics and Sports Injuries, School of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
2 Department of Biomechanics and Sports Injuries, School of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
10.48305/jrrs.2026.46289.1144
Abstract
Introduction: Chronic non‑specific low back pain (LBP) has a high prevalence among nurses, and exercise interventions are proposed as a non‑pharmacological treatment. However, the exact mechanism of their effect is not well understood. The novel COVIN (Compressive‑Venous‑Inflammatory) pathogenetic model may provide a theoretical framework to explain these mechanisms. This scoping review aimed to review exercise interventions in nurses with chronic non‑specific LBP and to analyse their mechanism of action based on the COVIN model.
Materials and Methods: A scoping review was performed in PubMed, Scopus, SID, and Magiran databases using keywords related to nurses, chronic non‑specific LBP, and exercise therapy, from 2017 to 2026 (and the equivalent Persian years 1395 to 1404). Original studies (randomized/non‑randomized controlled trials, quasi‑experimental) that examined an exercise intervention in nurses with chronic non‑specific LBP were included. Finally, eight original studies met the inclusion criteria and were selected for analysis.
Results: From the eight included studies (five clinical trials and three quasi‑experimental studies), the most effective exercise interventions were progressive core stability training, William’s flexion exercises, aquatic exercise, resistance training, and combined approaches (exercise + ergonomic education). Analysis based on the COVIN model revealed that William’s flexion exercises and aquatic exercise act by reducing venous congestion in the Batson plexus (Venous factor) and decreasing pressure on nerve roots (Compressive factor). Combined approaches that simultaneously targeted all three COVIN factors showed the highest effectiveness.
Conclusion: A variety of exercise interventions are effective in reducing chronic non‑specific LBP in nurses. The COVIN model provides a powerful theoretical framework for understanding their mechanism of action. Combining exercise with ergonomic education, flexion exercises, aquatic therapy, and progressive core stability training is recommended, especially in younger nurses.
Keywords
Chronic non‑specific low back pain
Nurses
Exercise therapy
William’s flexion exercises
CoVIn model
Subjects
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