Can a herniated disc in the neck cause blurred vision? Chronic Neck Pain and Vision Problems

Ross Hauser, MD

Cervical neck instability causes a myriad of symptoms such as pain, dizziness, tinnitus, vertigo, sinusitis, swallowing difficulty and others. In this article, our focus will be on vision problems.

In their 2014 paper: Characteristics of visual disturbances reported by subjects with neck pain. Researchers at The University of Queensland wrote in the journal Manual Therapy of the most troublesome visual disturbances in subjects with neck pain(1).

  • The most prevalent symptoms were ‘need to concentrate to read‘ (70%) and ‘sensitivity to light‘ (58.6%).
  • Lesser prevalent but still impacting many were: ‘double vision‘ (28.6%) and ‘dizzy reading‘ (38.6%).
  • The most troublesome symptoms were
    1. ‘need to concentrate to read’
    2. ‘visual fatigue’
    3. ‘difficulty judging distances’
    4. and ‘sensitivity to light’

Let’s do some simple definitions before we proceed.

  • The vestibular system is the body’s sensory system that regulates balance and spatial orientation (the understanding of where you are in your environment).
    • It sits in the inner ear and works by adjusting fluid levels that act as the balance mechanism.
    • In human beings, we set our awareness of our place in space by using the ground as the constant place of orientation. We can keep our balance when we walk because we understand the ground is the constant and our vestibular system makes constant involuntary adjustments to “keep things steady.”
  • The vestibulo-ocular reflex is part of the vestibular system. It is a reflex eye movement that stabilizes images during head rotation.
  • The cervico-ocular reflex is a vision stabilization reflex that is called on by the rotation of the neck when your trunk turns sideways but your head does not turn. Such as rotating either shoulder so it sits under your chin or the trunk rotation during power walking or nordic type exercises.
  • The vestibulo-ocular reflex and the cervico-ocular reflex work in conjunction with the optokinetic reflex (your ability to follow moving objects).

While these are very simple definitions, they get the point across that the vestibular system is a complex, delicate balancing system that stabilizes vision. More simply, it “keeps your eye steady.”

One more definition:

  • Cervical afferent dysfunction. This is a medical term to describe blockage or dysfunction of nerve messages or blood flow in the neck.

Now to the research

Dr. Julia Treleaven, PhD, is a member of the Neck Pain and Whiplash Research Group, Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia. She has also written numerous papers on the problems of impaired function in the cervical neck. The paper cited at the top of this article is one that she co-authored.

In the July 2017 edition of The Journal of Orthopaedic and sports physical therapy she wrote:

There is considerable evidence to support the importance of cervical afferent dysfunction in the development of dizziness, unsteadiness, visual disturbances, altered balance, and altered eye and head movement control following neck trauma, especially in those with persistent symptoms.

However, there are other possible causes for these symptoms, and secondary adaptive changes should also be considered in differential diagnosis.

Understanding the nature of these symptoms and differential diagnosis of their potential origin is important for rehabilitation. In addition to symptoms, the evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility (eye muscle movement) and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion and vestibular or visual pathology or deficits. (2)

Can a herniated disc in the neck cause blurred vision?

In our offices, we see patients following an acute head or neck trauma, such as concession, whiplash, sports injury who suffer from these various problems including double vision and other vision problems. But as pointed out in this study, we also see patients with the same symptoms who suffer from cervical degenerative disc disease.

In the journal Physical Therapy, researchers lead by the Erasmus University Medical Center in the Netherlands showed the cervico-ocular reflex could be altered in non-traumatic neck pain patients.(3)

Here again, the problems of vision connected to cervical degenerative disc disease. To show the similarities between the non-traumatic neck pain patients and the traumatic neck pain patients, the researchers noted the same symptoms in patients with Whiplash Associated Disorder (WAD).

  • What the researchers found in both groups was an increased cervico-ocular reflex. Increased cervico-ocular reflex is not a good thing, it is a vision impairment.

The researchers offer an explanation for the increased cervico-ocular reflex in people with neck pain as altered afferent information from the cervical spine. (The blockage or dysfunction of nerve messages or blood flow in the neck that we mentioned above).

Quoting the study: “In the cervical spine, the information from muscles is a dominant source of information. Deficits in afferent information are suggested by magnetic resonance imaging studies showing a widespread presence of fatty infiltrates in the neck muscles of patients with chronic whiplash and to a lesser extent in patients with idiopathic neck pain (neck pain that is coming from an undiagnosed source).”

So the researchers are looking at problems of neck stability and movement caused by muscle atrophy. They also suggest that a reduced range of motion in the neck alters the afferent information from the cervical spine. In our practice, we look also at the problems of cervical ligament instability.

One more problem. The vestibulo-ocular reflex and the cervico-ocular reflex work in conjunction, as the researchers noted:

“the vestibular and cervical system cooperate in order to maintain a clear visual image during head and eye movements. (These)  findings suggest that the vestibulo-ocular reflex does not compensate for the increased cervico-ocular reflex in the neck pain group.

This mismatch between cervico-ocular reflex and vestibulo-ocular reflex could lead to visual disturbances, dizziness, and postural control disturbances.”

The researchers then speculated a question that they said they would look at in a future study:

Is it possible to use the cervico-ocular reflex as an outcome measure to evaluate the effectiveness of interventions in people with neck pain? In other words, does vision improvement mean the treatment is working? A patient who has vision impairment improved by neck pain treatments would certainly think so. That is something we have seen here in our practice.

Caring Medical research

Caring Medical has published numerous research studies on cervical neck instability and the symptoms it can cause: This research is below:

Prolotherapy Treatment with DMX

One of the technologies that we use that Caring Medical is called digital motion x-ray. The patient in the video below had several Prolotherapy treatments done in our office and she was improving but I really felt I had to be more aggressive with her C1 – C2 instability. You will see where the needle is going toward C2 facet joints. This particular patient did extremely well with the treatment.

Digital motion x-ray digital motion x-ray is a great method to document cervical instability. It is a fluoroscopic x-ray that is taken while the patient moves his/her neck. Below I am using the digital motion x-ray to do injections of this particular patient who has upper cervical instability.

Do you have questions about vision problems and chronic neck pain? You can get help and information from our Caring Medical Staff

1 Treleaven J, Takasaki H. Characteristics of visual disturbances reported by subjects with neck pain. Manual therapy. 2014 Jun 1;19(3):203-7.

2 Treleaven J. Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jun 16(0):1-25.

3 de Vries J, Ischebeck BK, Voogt LP, Janssen M, Frens MA, Kleinrensink GJ, van der Geest JN. Cervico-ocular reflex is increased in people with nonspecific neck pain. Physical therapy. 2016 Aug 1;96(8):1190-5.

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