Associate Professor Jason Kutch developed chronic pelvic pain in his 20s, a condition that eventually became “debilitating and impactful.”

When he moved to Los Angeles in 2008 as a postdoctoral researcher in biomedical engineering, he took up surfing and made a huge, personal discovery: after spending time in the ocean surfing, his pain would subside.

“I started to notice that not only would I be out of pain immediately afterwards — which might have something to do with distraction — but it also seemed to make it less likely that I’d have pain on other days even when I wasn’t surfing,” Kutch says. “It seemed to have this restorative effect.”

After seeing a movie about veterans with post-traumatic stress disorder getting relief from surfing, Kutch had an idea: What if he could study this in a rigorous way?

“I had a dream of taking an MRI machine on a truck up to the surf break and scanning people’s brains before and after surfing,” he says.

Thanks to a Southern California Clinical and Translational Science Institute Multidisciplinary Pilot Grant, Kutch and colleagues Associate Professor James Finley and Gabilan Assistant Professor of Computer Science Heather Culbertson will be able to study how surfing impacts chronic pain sufferers — both in the water and on a complex virtual reality wave.

Surfer’s High

One in five Americans suffer from chronic pain, and the researchers’ hope is to understand if ocean surfing therapy could help a group of patients who have had few options for relief.

“There is mounting evidence that many patients with chronic pain have problems with neural signaling that may make it difficult to think about anything other than pain,” Kutch says. “The idea is that the really dynamic environment of surfing might force the brain to focus outside the body and restore a better signaling balance.”

The research team will study two things: how surfing affects the brain, and how to engineer a virtual reality simulation detailed enough to replicate surfing’s benefits to expand access.

To answer those questions, the new study will be multifaceted. First, the team will use an EEG-powered headband to image the brains of study participants each week, before and after a session of surf therapy. They will also scan the brains of experienced surfers to see what happens after a surfing session.

Additionally, they will develop a virtual reality setup, using a motion platform that mimics the sensation of a surfboard. In the first phase, Kutch says they’ll create an immersive environment where the person is sitting on the board wearing a headset while it rocks — basically waiting for a wave in the lineup.

They’ll use both pain patients and skilled surfers to evaluate it. The second phase will bring a dynamic riding of the wave, as the patients stand up and surf in virtual reality.

They hope to find out what part of surfing brings pain relief — is it the dynamic environment of the ocean, or the full-body experience of water, or the act of catching a wave?

From Kutch’s experience, being in the environment is important, but there’s something about the challenge of getting that first wave and successfully riding it.

“I love the idea of trying to figure out how to have people in the water as well and have a more dynamic environment, he says. “And I’m not sure how to do that yet. This piece of equipment is not going to get wet.”

A Fully Immersive Experience

The study is also unique in its multidisciplinary partners. Finley has been working for a decade on developing virtual reality-based applications for neuromotor rehabilitation — mostly on ways to recreate mobility-related challenges that people face in the real world.

“One of the nice things about virtual reality is that we can fully control what people see. We can also add a layer of audio and even haptics — where people have some sensory feedback based on their interaction with objects in the virtual environment.”

The system will start with a full motion simulator that you might typically see at a theme park, with a surfboard attached, says Culbertson, who is a faculty member of the USC Viterbi School of Engineering. She is going to program the motion system hardware so that researchers can realistically create the sensation of waves and match it to visual graphics in virtual reality — something that may also include ocean smell and breezes. “We’re not trying to gamify the experience,” she says. “It’s meant to be a fully immersive kind of calming experience that allows users to get that surfer’s high.”

To build the system, the team will gather recordings of surfers to measure their motions using waterproof sensors. They’ll use those to program the device. Recording video is easy, she says — but recording haptics is challenging.

“If we want this to feel realistic, then we need to have those haptic sensations to understand what the user is actually feeling when surfing on real waves,” she says.

Overall, the team hopes to gain a better understanding of how surfing could help chronic pain patients — and figuring out how to make the activity available to a wider swath of people.

Kutch says if the pilot is successful, it could grow into something larger: “I’m really hopeful that we could boil a component of the VR down to a bare minimum that’s needed, and then actually be able to get that out to a lot of people as something they can use in their home or at their local pool in a more practical way.”