Functional training and dual task as a treatment option for chronic low back pain

Low back pain is the leading cause of disability worldwide. Physical exercise is currently recommended for chronic low back pain (CLBP), promoting reductions in pain intensity and improvements in physical function. Functional training (FT), defined as exercises aimed at improving performance in daily and sports activities, is a promising approach for improving trunk stability and functional capacity and may increase endogenous analgesic responses. Dual-task training (DTT), which involves simultaneous motor and cognitive tasks, may modulate pain-related circuits and activate brain areas involved in attention and cognition, potentially contributing to pain reduction. However, the pathways through which FT and DTT promote these effects remain unclear. Therefore, this narrative review aimed to discuss the possible pathways through which FT and DTT may reduce pain and improve trunk stability and functional capacity in people with CLBP. A structured search was conducted in PubMed, PEDro, and Scopus for studies published up to March 2025. Searches combined terms related to low back pain, functional training, multicomponent exercise, and dual-task training using Boolean operators. Studies involving humans with low back pain, published in peer-reviewed journals in English or Portuguese, were considered, and reference lists were screened for additional relevant studies. The evidence suggests that FT and DTT may produce complementary physiological and neurocognitive effects. However, several proposed mechanisms, particularly those involving endogenous opioids and chronic neurophysiological adaptations, remain hypothetical and require further experimental confirmation.