Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 20 2 2026 02 10 211 224 Thandavamurthy Jayasree Department of Biomedical Engineering, College of Engineering Guindy, Anna University, Chennai, India. Palchamy Pragathi Department of Biomedical Engineering, College of Engineering Guindy, Anna University, Chennai, India. Saravanan Premkumar Department of Biomedical Engineering, College of Engineering Guindy, Anna University, Chennai, India. Senthilkumar Revathi Sree Krishna Department of Biomedical Engineering, College of Engineering Guindy, Anna University, Chennai, India. 2025 10 10 2026 02 10 Introduction: Back pain remains a prevalent musculoskeletal condition with significant implications for quality of life and long-term spinal health. Conventional rehabilitation approaches often suffer from low patient adherence and limited engagement, highlighting the need for innovative, technology-driven solutions that motivate sustained therapeutic participation. Materials and Methods: A real-time pose detection system was integrated with a Unity-based gaming platform to deliver personalized exercise regimens targeting flexibility, strength, and postural correction. The system incorporated computer vision algorithms for real-time biomechanical analysis and immediate performance feedback. Three therapeutic exercises were evaluated: the knee-to-chest stretch (cross crunches), side bend, and forward and backward bends. Exercise performance was gamified within the Unity engine to enhance user motivation and adherence. Results: The system successfully detected and analysed user performance across all three target exercises in real time. A measurable improvement in user scoring patterns was observed over successive sessions, indicating enhanced engagement and more effective exercise execution. The gamified framework demonstrated reliable performance analysis and responsiveness to individual rehabilitation needs. Conclusion: Integrating real-time pose detection with interactive game-based environments represents a viable and scalable approach to back pain rehabilitation. By transforming therapeutic exercises into engaging gameplay, the proposed system promotes greater adherence to treatment protocols and supports superior long-term spinal health outcomes. The framework's adaptability positions it as a promising tool for individuals with diverse rehabilitation requirements. https://jmr.tums.ac.ir/index.php/jmr/article/view/1445