Manage Fibromyalgia Pain with Virtual Reality Physical Therapy


Fibromyalgia (FM) is a pain syndrome that affects mostly women, although some men also suffer from the condition. The disorder is characterized by widespread heightened pain in muscles and joints, sleep disorders, poor balance, stiffness, depression, anxiety and low fitness levels.

Treatment of FM often focuses on pharmacological interventions and physical activities that promote balance and mobility. The primary objectives of treatment are to reduce pain and increase physical function, to improve performance of activities of daily living, and to enhance overall quality of life. Recently, virtual reality (VR) games have drawn attention as a potential alternative treatment for FM.

Characteristics of VR Rehabilitation

VR games use computer software that shows movements on a screen that the patient is asked to mimic, or sets goals that the patient must attain through physical actions. Programs can be modified to target specific body areas, and to change the level of difficulty. The system gives immediate visual feedback on how well the patient is performing.

VR games can be geared to aerobic activities like walking or dancing, postural control and coordination, or mobility and balance skills. A technician can select and control the types of activities and the level of difficulty for each patient. Activities can be selected according to patient preference. Key points for successful VR training include social interaction, games that pose progressive challenges, therapeutic movement patterns, and immediate feedback.

Can VR Games Help FM Patients?

Exercise is known to improve FM symptoms, but adherence to exercise outside the clinical setting is often poor. Researchers Collado-Mateo et al., (2017) wanted to know if virtual reality games would be more motivating and enjoyable than traditional exercise in treating FM, and they set out to evaluate the effects of virtual reality (VR) games on mobility, balance and fear of falling in FM patients.

The randomized controlled study involved 76 female FM patients who were divided into two groups. The first group underwent an eight-week exercise intervention two times per week using VR games, while the control group continued in their regular activities. Baseline measurements of balance, fear of falling and mobility were established using standardized assessments. After eight weeks, patients were retested to see if VR rehabilitation had significantly improved balance, mobility and fear of falling in the experimental group, compared to the control group.

Results revealed:

  • The exercise group exhibited significantly improved mobility
  • The exercise group demonstrated significantly improved balance
  • The exercise group reported a significantly reduced fear of falling

Exercise adherence was high during the experiment, with only one patient dropping out of the program. The research team concluded that VR games may provide an effective tool for treating FM patients, to promote exercise adherence, improve balance and mobility, and reduce the fear of falling.

Virtual Rehab at NYDNR

At NYDNR, we use virtual reality physical therapy to treat a number of conditions, including fibromyalgia. Our high-tech clinic features C.A.R.E.N, a computer assisted rehabilitation environment that immerses patients in virtual reality as they perform various movement patterns and react to alterations in the training platform. C.A.R.E.N taps into the brain’s neuroplasticity to retrain faulty motor patterns and improve balance and mobility. Contact NYDNR today, to schedule your first C.A.R.E.N session.


Collado-Mateo, Daniel, et al. “Exergames for women with fibromyalgia: a randomised controlled trial to evaluate the effects on mobility skills, balance and fear of falling.” PeerJ 5 (2017): e3211.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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