Immediate effect of virtual reality intervention on task related neck pain and muscle fatigue in dentists


  • Shabarish Menon Department of Musculoskeletal Physiotherapy, D. Y. Patil Deemed to be University, School of Physiotherapy, Nerul, Navi Mumbai, Maharashtra, India
  • Twinkle Dabholkar Department of Musculoskeletal Physiotherapy, D. Y. Patil Deemed to be University, School of Physiotherapy, Nerul, Navi Mumbai, Maharashtra, India
  • Isha Shripad Cardiovascular and Respiratory Department, St. Andrews College of Physiotherapy, Pune, Maharashtra, India



Pain pressure threshold, Task specific neck pain, Virtual Reality intervention


Background: Dentistry requires long hours of static body postures while executing activities in which permanently forced loads influence the musculoskeletal system.

Methods: 25 dentists were recruited where neck pain or fatigue was assessed subjectively using NRS and Borg CR10 scale respectively and the pain pressure threshold of the upper trapezius muscle was assessed objectively using a handheld algometer pre- and post- intervention. Mobile VR game- Froggy VR was administered as a virtual reality.

Results: A Wilcoxon signed rank test showed a statistically significant reduction in the intensity of task related neck pain and fatigue post VR intervention with Z-score=-4.549, n=38, p<0.001 and Z-score=-4.588, n=38, p<0.001 respectively. Also, there was a statistically significant increase in the pain pressure threshold of the right and left upper trapezius muscle post VR intervention with Z-score=-4.937, n=38, p<0.001 and Z-score=-4.512, n=38, p<0.001 respectively.

Conclusions: Virtual reality intervention led to an immediate reduction in task-related neck pain and muscle fatigue among dentists with an immediate reduction in pain sensitivity of the upper trapezius muscle in dentists.


Ohlendorf D, Erbe C, Nowak J, Hauck I, Hermanns I, Ditchen D, et al. Constrained posture in dentistry- a kinematic analysis of dentists. BMC Musculoskel Disord. 2017;18(1):1-5.

Pîrvu C, Pătraşcu I, Pîrvu D, Ionescu C. The dentist’s operating posture–ergonomic aspects. J Med Life. 2014;7(2):177.

Magdalene M, Premavathy D. Prevalence of neck pain among dentists. Drug Invent Today. 2019;12(8).

Shinde V, Desousa SP. Neck pain amongst dentists in mumbai: an exploratory study. J Res Adv Dent 2015;4(1s):43-6.

Prudhvi K, Murty KR. Self-reported musculoskeletal pain among dentists in Visakhapatnam: a 12-month prevalence study. Indian J Dent Res. 2016;27(4):348-52.

Feng B, Liang Q, Wang Y, Andersen LL, Szeto G. Prevalence of work- related musculoskeletal symptoms of the neck and upper extremity among dentists in China. BMJ Open. 2014;4(12).

Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskel Disord. 2004;5(1):1-8.

Keefe F, Nowlin L, France CR, Zakhidov D, Trost Z, Zielke M, et al. The promise and challenge of virtual gaming technologies for chronic pain: the case of graded exposure for low back pain. Pain Manag. 2015;5(3):197-206.

Marques FLSN, Costa RMEM, Machado LS, Moraes RM. Virtual reality for health in Brazil: concepts, challenges and opportunities. Rev Bras Eng Biomed. 2011;27(4):243-58.

Malinska M, Zuzewicz K, Bugajska J, Grabowski A. Heart rate variability (HRV) during virtual reality immersion. Int J Occup Saf Ergon. 2015;21(1):47-54.

Pourmand A, Davis S, Marchak A, Whiteside T, Sikka N. Virtual reality as a clinical tool for pain management. Curr Pain Headache Rep. 2018;22(8):53.

Massetti T, da Silva TD, Crocetta TB, Guarnieri R, de Freitas BL, Bianchi Lopes P, et al. The clinical utility of virtual reality in neurorehabilitation: a systematic review. J Cent Nerv Syst Dis. 2018;10:1179573518813541.

Oing T, Prescott J. Implementations of virtual reality for anxiety-related disorders: systematic review. JMIR Serious Games. 2018;6(4):e10965.

Tsai CF, Yeh SC, Huang Y, Wu Z, Cui J, Zheng L. The effect of augmented reality and virtual reality on inducing anxiety for exposure therapy: a comparison using heart rate variability. J Healthcare Eng. 2018;25:6357351.

Kenney MP, Milling LS. The effectiveness of virtual reality distraction for reducing pain: a meta-analysis. Psychol Conscious Theory Res Pract. 2016;3(3):199.

Treleaven J, Battershill J, Cole D, Fadelli C, Freestone S, Lang K, et al. Simulator sickness incidence and susceptibility during neck motion-controlled virtual reality tasks. Virt Real. 2015;19(3):267-75.

Song Z, Han T, Zhu D, Xie Y, Xiao H, Shen T, et al. Study on the effect of cervical spine somatosensory games of virtual reality and augmented reality on relieving neck muscle fatigue. Int Conference on Human-Computer Interaction. Springer International Publishing; 2020:359-375.

Binder AI. Cervical spondylosis and neck pain. BMJ. 2007;334(7592):527-31.

Young IA, Dunning J, Butts R, Mourad F, Cleland JA. Reliability, construct validity, and responsiveness of the neck disability index and numeric pain rating scale in patients with mechanical neck pain without upper extremity symptoms. Physiother Theory Pract. 2019;35(12):1328-35.

Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomás M, et al. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskel Disord. 2008;9(1):1-9.

Silva TC, Bandeira PM, Ranzatto AD, Meziat-Filho NA, Nogueira LA, Fernandes Júnior O, et al. Comparison of the effect of two virtual reality stimuli on pressure pain sensitivity and autonomic response. BrJP. 2021;3:328-32.

Li A, Montaño Z, Chen VJ, Gold JI. Virtual reality and pain management: current trends and future directions. Pain Manage. 2011;1(2):147-57.

Mallari B, Spaeth EK, Goh H, Boyd BS. Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J Pain Res. 2019;12:2053.

Ahern MM, Dean LV, Stoddard CC, Agrawal A, Kim K, Cook CE, et al. The effectiveness of virtual reality in patients with spinal pain: a systematic review and meta‐analysis. Pain Pract. 2020;20(6):656-75.

Colloca L. The placebo effect in pain therapies. Ann Rev Pharmacol Toxicol. 2019;59:191-211.

Colloca L, Klinger R, Flor H, Bingel U. Placebo analgesia: psychological and neurobiological mechanisms. Pain. 2013;154(4):511.

Ahmad I, Kim JY. Assessment of whole body and local muscle fatigue using electromyography and a perceived exertion scale for squat lifting. Int J Environ Res Public Health. 2018;15(4):784.

Jo D, Bilodeau M. Rating of perceived exertion (RPE) in studies of fatigue- induced postural control alterations in healthy adults: Scoping review of quantitative evidence. Gait Post. 2021;90:167-78.

De Sio S, Traversini V, Rinaldo F, Colasanti V, Buomprisco G, Perri R, et al. Ergonomic risk and preventive measures of musculoskeletal disorders in the dentistry environment: an umbrella review. PeerJ. 2018;6:e4154.

Montoya MF, Muñoz JE, Henao OA. Enhancing virtual rehabilitation in upper limbs with biocybernetic adaptation: the effects of virtual reality on perceived muscle fatigue, game performance and user experience. IEEE Transact Neural Syst Rehabil Engin. 2020;28(3):740-7.

Walton D, MacDermid J, Nielson W, Teasell R, Chiasson M, Brown L. Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. J Orthopaed Sports Phys Ther. 2011;41(9):644-50.

Martínez-Segura R, De-La-Llave-Rincón AI, Ortega-Santiago R, Cleland JA, Fernandez-De-Las-Penas C. Immediate changes in widespread pressure pain sensitivity, neck pain, and cervical range of motion after cervical or thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain: a randomized clinical trial. J Orthopaed Sports Phys Ther. 2012;42(9):806-14.

Waller R, Straker L, O’Sullivan P, Sterling M, Smith A. Reliability of pressure pain threshold testing in healthy pain free young adults. Scand J Pain. 2015;9(1):38-41.

Uddin Z, MacDermid JC. Quantitative sensory testing in chronic musculoskeletal pain. Pain Med. 2016;17(9):1694-703.

Hven L, Frost P, Bonde JP. Evaluation of pressure pain threshold as a measure of perceived stress and high job strain. PloS One. 2017;12(1):e0167257.

Wassinger CA, Rich D, Cameron N, Clark S, Davenport S, Lingelbach M, et al. Cervical and thoracic manipulations: acute effects upon pain pressure threshold and self-reported pain in experimentally induced shoulder pain. Man Ther. 2016;21:227-32.

Aboodarda SJ, Spence AJ, Button DC. Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage. BMC Musculoskel Disord. 2015;16(1):1-10.

Imamura M, Chen J, Matsubayashi SR, Targino RA, Alfieri FM, Bueno DK, et al. Changes in pressure pain threshold in patients with chronic nonspecific low back pain. Spine. 2013;38(24):2098-107.

Özdolap Ş, Sarikaya S, Köktürk F. Evaluation of pain pressure threshold and widespread pain in chronic low back pain. Turk J Phys Med Rehabil. 2014;60(1).

Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895-926.

Gutiérrez-Maldonado J, Gutiérrez-Martínez O, Loreto-Quijada D, Nieto- Luna R. The use of virtual reality for coping with pain with healthy participants. Psicothema. 2012;24(4):516-22.




How to Cite

Menon, S., Dabholkar, T., & Shripad, I. (2023). Immediate effect of virtual reality intervention on task related neck pain and muscle fatigue in dentists. International Journal Of Community Medicine And Public Health, 10(7), 2447–2456.



Original Research Articles