Chronic low back pain is one of the main reasons for physiotherapy consultation and one of the leading causes of disability in the world. However, its management remains complex: persistent pain, fear of movement, loss of quality of life. In this context, virtual reality appears to be a promising complementary approach. What does science really say about its effectiveness against chronic low back pain? This article takes stock of the available clinical evidence and concrete applications for physiotherapists.

Chronic low back pain: why is it so difficult to treat?

Chronic low back pain is defined as lower back pain that persists for more than three months. Unlike acute low back pain, which usually heals spontaneously, the chronic form settles into a complex vicious circle where pain is no longer just a physical symptom.

Indeed, two factors maintain chronicity and often resist conventional rehabilitation:

• Kinesiophobia (fear of movement): the patient avoids the gestures he associates with pain, which leads to muscle deconditioning and aggravates the situation.
• Catastrophizing pain : the patient anticipates and mentally amplifies the pain, which increases his or her real perception.

It is precisely on these two dimensions that virtual reality brings added value, in addition to traditional approaches.

What the science says about VR and chronic low back pain

The scientific literature on this subject is now abundant and of good quality. Several reference studies provide guidance to practitioners.

The strongest synthesis is the meta-analysis by Brea-Gómez et al. (2021), published in the International Journal of Environmental Research and Public Health. After analysis of all available randomized controlled trials, the authors conclude that virtual reality significantly reduces pain intensity and kinesiophobia in patients with chronic low back pain, both immediately after the intervention and at remote monitoring.

In addition, the randomized controlled trial by Matheve et al. (2020), published in the Journal of NeuroEngineering and Rehabilitation, demonstrated a hypoalgesic effect (pain reduction) of virtual reality distraction, both during and immediately after exercise. The study also showed that VR reduces the time the patient spends thinking about their pain.

Finally, and of particular interest to H’ability, the study by Garcia et al. (2021) was conducted on a stand-alone PICO-type helmet — the same family of hardware used by H’ability. This at-home VR program reduced the intensity of the pain and its impact on activities, mood, and stress. Above all, a 6-month follow-up confirmed the durability of these effects, an essential point in the management of a chronic pathology.

How does virtual reality work on lower back pain?

The mechanisms of action of VR against chronic low back pain are now well identified. There are three main ones.

• Cognitive distraction: by immersing the patient in a playful environment, VR diverts their attention from the pain. This mechanism produces a measurable hypoalgesic effect, as demonstrated in the study by Matheve et al.
• Reduction of kinesiophobia: by recontextualizing the gesture in the form of a game, VR encourages the patient to mobilize his or her back without apprehension. He achieves amplitudes that he forbade himself, in a secure environment.
• Remotivation and compliance: gamified exercises maintain the patient’s commitment over time, a major challenge in long-term rehabilitation.

By recontextualizing movement, virtual reality helps the patient to break the vicious circle of pain-avoidance-deconditioning that characterizes chronic low back pain.

What concrete applications with H’ability?

The H’ability system offers several categories of exercises adapted to the management of chronic low back pain:

• Thoracolumbar mobility: spinal mobility exercises and reduction of back pain, in progressively increasing amplitudes.
• Paravertebral strengthening: targeted muscle work to restore sheathing and postural control.
• Balance and postural control work: particularly useful for elderly patients, as shown in the study by Yalfani et al. (2022) on the reduction of the risk of falling.
• Kinesiophobia management: playful environments that distract from pain and restore confidence in movement.
• Immersive relaxation: relaxation exercises to reduce anxiety and the emotional component of chronic pain.

For an overview of the clinical situations covered, see our H’ability therapeutic indications.

A complementary tool, not a substitute

It is essential to remember that virtual reality does not replace conventional physiotherapy. As demonstrated in the trial by Afzal et al. (2022), it is the combination of VR and routine physiotherapy that produces the best effect on functional disability and low back pain. VR enriches the therapeutic arsenal of the physiotherapist, without replacing it. In addition, the H’ability device is not indicated for patients with severe behavioral disorders.

“With H’ability, the person can perform movements in a safe environment. It is often a source of wonder for them to realize that they have succeeded in a gesture, and without having been in pain, without them realizing it during the exercise. »

— Ninon Playe, occupational therapist, LADAPT de l’Aube

FAQ — Frequently asked questions about chronic low back pain and virtual reality

Is virtual reality effective against chronic low back pain?
Yes. A meta-analysis by Brea-Gómez et al. (2021) shows that virtual reality significantly reduces pain intensity and kinesiophobia in patients with chronic low back pain, both after the procedure and at follow-up. In addition, VR is particularly effective as a complement to conventional physiotherapy.

How does virtual reality work on lower back pain?
Virtual reality acts through two main mechanisms: cognitive distraction, which diverts the patient’s attention from pain (hypoalgesic effect demonstrated by Matheve et al., 2020), and the reduction of kinesiophobia, the fear of movement that maintains chronicity. Thus, by recontextualizing the gesture in the form of a game, VR encourages the patient to move without apprehension.

Does VR for back pain work at home?
Yes. A randomized controlled study by Garcia et al. (2021), conducted on a standalone headset, showed that a home VR program reduces the intensity of pain and its impact on activities, mood, and stress. In addition, a 6-month follow-up confirmed the durability of these effects.

Which patients with low back pain can benefit from virtual reality?
Virtual reality is particularly suitable for patients suffering from chronic low back pain with strong kinesiophobia, as well as for the elderly. Indeed, a study by Yalfani et al. (2022) showed benefits on pain, fall risk and quality of life in older women with chronic low back pain.

Does VR replace physical therapy for back pain?
No. Virtual reality is a complementary tool to physiotherapy, not a substitute. In contrast, studies show that the best outcomes are achieved when VR is combined with conventional rehabilitation, as demonstrated by Afzal et al. (2022).

References:

• Brea-Gómez, B., Torres-Sánchez, I., Ortiz-Rubio, A., Calvache-Mateo, A., Cabrera-Martos, I., López-López, L., & Valenza, M. C. (2021). Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. International Journal of Environmental Research and Public Health, 18(22), 11806. Read the study
• Matheve, T., Bogaerts, K., & Timmermans, A. (2020). Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: a randomized controlled trial. Journal of NeuroEngineering and Rehabilitation, 17(1), 55. Read the study
• Garcia, L. M., et al. (2021). An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19. Journal of Medical Internet Research, 23(2), e26292. Read the study
• Afzal, M. W., et al. (2022). Effects of virtual reality exercises and routine physical therapy on pain intensity and functional disability in patients with chronic low back pain. Journal of the Pakistan Medical Association, 72(3). Read the study
• Yalfani, A., Abedi, M., & Raeisi, Z. (2022). Effects of an 8-Week Virtual Reality Training Program on Pain, Fall Risk, and Quality of Life in Elderly Women with Chronic Low Back Pain. Games for Health Journal, 11(2), 85–92. Read the study

Sources:

• Featured image – Author jcomp : https://www.magnific.com/free-photo/close-up-man-rubbing-his-painful-back-isolated-white-background_1602564.htm