Does virtual reality contribute to the prevention of musculoskeletal disorders at work: a systematic review

Imagine a factory floor where the workstations are not yet built, but the people who will use them are already at risk. Musculoskeletal disorders, the aching muscles and strained tendons that plague workers, often stem from how a job is designed before a single tool is picked up. For decades, engineers have tried to solve this by building physical models or using computer simulations, but these methods sometimes miss the human element. They fail to capture how a real person feels, moves, and reacts when they are truly immersed in a task. Enter virtual reality, a technology that has moved beyond gaming to become a laboratory for the human body. By placing a worker inside a digital version of their future job, designers can watch how they move, where they stretch, and what hurts, all before the first brick is laid. The goal is simple but profound: to fix the design before the injury happens.

A team of researchers set out to see if this high-tech approach is actually working. They conducted a systematic review, which is a method of gathering and analyzing every relevant study on a specific topic to find the big picture. They looked at twenty-three studies published between 2016 and 2025, focusing on how companies use virtual reality to design workstations and prevent back pain, shoulder strain, and other physical ailments. The researchers examined the hardware used, the software that built these digital worlds, and the methods used to check if the virtual experience was accurate enough to trust. They wanted to know if the body behaves the same way in a digital room as it does in a real one, and if the tools used to measure risk in the virtual world are reliable.

The picture that emerged is one of great promise mixed with significant gaps. Most of the studies they reviewed took place in the fields of engineering and manufacturing, where the primary focus was on assembly tasks, such as putting together car parts or aircraft components. The technology used was quite advanced; the majority of the studies relied on headsets that cover the eyes, similar to those used for gaming, combined with motion capture systems that track the movement of the body. These systems often used software like Unity 3D, a platform commonly used to build interactive environments, to create the digital workspaces. In these virtual spaces, operators would perform tasks like lifting, twisting, or reaching for tools, while the computer recorded their every move to calculate the stress on their joints.

However, the review found a troubling pattern: most of the studies did not actually prove that the virtual world was a faithful copy of reality. Out of the twenty-three studies, fifteen simply used the virtual environment to spot risky postures without ever checking if the results matched what would happen in the real world. It was as if a doctor diagnosed a patient based on a drawing without ever seeing the patient. While these studies successfully identified dangerous positions, they lacked the crucial step of validation. Only eight studies went further to test the technology. Six of these compared the data from the virtual environment against data collected from real people doing real tasks, or against digital human models. The results of these comparisons were mixed. In some cases, the virtual environment worked well, showing similar joint angles and movement patterns to the real world. In others, there were noticeable differences. For instance, one study found that people spent more time in risky positions in the virtual world than they did in reality, likely because the headset limited their peripheral vision, forcing them to turn their heads more than they would naturally. Another study noted that without the weight of a real object in their hands, users held their arms in different positions than they would if they were holding a heavy part.

The researchers also looked at how the users felt while wearing the equipment. They found that people generally felt present in the virtual world, meaning they felt like they were truly "there," which is essential for the simulation to work. However, some users reported increased mental effort or discomfort, known as cybersickness, which can happen when the brain receives conflicting signals from the eyes and the body. This suggests that while the technology is powerful, it is not yet perfect. The studies that did compare virtual and real results often found that the virtual environment could overestimate or underestimate the risk, depending on how realistic the simulation was. For example, if the virtual environment did not include the resistance of a heavy object, the user might not feel the strain they would in reality, leading to a false sense of safety. Conversely, if the graphics were poor or the movement was laggy, the user might struggle more than necessary, making the job look harder than it actually is.

Despite these limitations, the studies showed that virtual reality can be a useful tool for improving workstation design. In the few cases where researchers redesigned a workstation based on virtual reality feedback and then re-evaluated it, the risk scores for musculoskeletal disorders went down. This suggests that the technology can help identify problems and guide improvements. Yet, the researchers cautioned that these findings are not yet a final solution. The studies were often small, involving only a handful of participants, and they rarely used strong statistical methods to prove that the improvements were real and not just a coincidence. The methods used to measure risk also varied widely from one study to another, making it difficult to compare results directly. Some used one method to score posture, while others used a different one, and some did not use any standard scoring at all.

The authors concluded that while virtual reality is gaining traction as a way to design safer workplaces, the field needs to mature. The current approach is often too experimental, with too many different ways of doing things and not enough proof that the digital simulations match the real world. To truly prevent injuries, the researchers argue that future studies must adopt standardized methods and rigorous testing. They need to ensure that the virtual environment feels and acts like the real one, from the weight of the tools to the resistance of the air. They also need to include more diverse groups of workers, not just healthy volunteers, to see how the technology works for the people who will actually be doing the job. Until these steps are taken, virtual reality remains a powerful but unproven ally in the fight against workplace injuries, offering a glimpse of a safer future but not yet guaranteeing it. The path forward requires a blend of technical precision and human understanding, ensuring that the digital tools we build to protect us are as real and reliable as the world they are meant to simulate.