Mirror Box Therapy

Mirror Box Therapy is an evidence based treatment option for people suffering from CRPS (complex regional pain syndrome), phantom limb pain, and chronic neuropathic pain. It works by utilising the brain's ability to reorganise itself, known as neuroplasticity.

Amazon Link to a Mirror Box

Mirror box therapy uses a treatment method called 'Graded Motor Imagery'. It works by helping the brain to re-learn normal movement patterns in the painful limb by accessing the already established patterns in the opposite non painful limb. 

It aims to trick the brain by creating the illusion of pain-free movement. It can be used by patients in their own home to treat a painful hand or foot. With practice, mirror box therapy can teach the brain to react normally to movement of the affected hand or foot, and not feel pain.


Mirror box therapy involves the patient sitting in front of a mirror box, with their affected limb placed into the box so the mirror blocks their view of it. The mirror is then positioned so that the patient sees a reflection of their normal limb in the position that would normally be occupied by their affected limb. This creates a visual illusion where the brain perceives touch or movement of the normal limb as coming from the painful limb.


Like other treatments for CRPS, the results from mirror box therapy will vary from patient to patient, but overall its a treatment which seems to show great potential in treating CRPS.

How Mirror Box Therapy Works

  1. Visual Feedback: With the affected limb hidden from view and the mirror reflecting the image of the unaffected limb, the patient watches the reflection of the intact limb as if it were the affected limb. This visual feedback tricks the brain into perceiving movement and sensation in the affected limb.


  3. Movement Replication: The patient then performs exercises or movements with the intact limb while observing the mirror reflection. This creates the illusion that the affected limb is also moving in the same way.


  5. Brain Reorganization: By repeatedly engaging in mirror box therapy, the brain begins to rewire itself. The visual feedback provided by the mirror helps to normalise the neural pathways associated with movement and sensation in the affected limb.


  7. Pain Reduction: Over time, mirror box therapy can lead to a reduction in pain perception associated with conditions like CRPS. This pain reduction is thought to occur as a result of the brain's plasticity and the restoration of more normal sensory processing.

Overall, mirror box therapy capitalises on the brain's ability to adapt and reorganise in response to sensory input, ultimately helping to alleviate pain and improve function in individuals with conditions affecting limb movement and sensation.


How to do Mirror Box Exercises

  • Find a quiet place and get comfortable
  • Remove any jewellery or other items from your limb to keep it bare and undisturbed
  • If you have a mirror box, place your affected hand or foot inside the box. Adjust the position of the mirror until it creates a realistic illusion that both limbs are present.

Start by performing gentle movements of your unaffected limb while keeping your gaze fixed on the reflection in the mirror.

Keep focussed and thinking that you are moving and exercising your CRPS-affected limb (while actually keeping it still). The idea is to 'trick' your mind into thinking you are moving the affected limb.


Upper Limb Exercises

  • Try simple gestures using your fingers, hand and arm. Try moving each 'healthy' finger while focusing on the reflection in the mirror.
  • Try tapping each individual finger against your thumb. Then try make a gentle fist and then flattening out your hand fully.

Lower Limb Exercises

  • Try to move your ankle up and down or in circles.
  • Point your toes downwards and and then upwards.
  • Use a foam roller underneath your foot and roll it slowly forwards and backwards.

Several short sessions with the mirror box each day is thought to be most effective. Ideally, 4 to 5 sessions, each lasting 5 to 10 minutes is recommended as long as pain is minimal and manageable. 

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