Chronic Neck Pain and Blurred Double Vision Problems – Is the answer in the neck ligaments?
Ross Hauser, MD | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
David N. Woznica, MD | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Katherine L. Worsnick, MPAS, PA-C | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
Danielle R. Steilen-Matias, MMS, PA-C | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
If you are reading this article, it is likely that you already know the answer to the question posed below. Can a herniated disc in the neck or whiplash cause blurred vision? The answer is yes. The next challenge. Can it be treated? If you are reading this article you have probably had treatments with less than hoped for results. A main reason for your lack of success is that your doctors may have focused solely on the blurry vision and not explored the greater problem of the soft tissue damage in your neck causing the blurred, double vision.
Can a herniated disc in the neck or whiplash cause blurred vision?
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. While vision problems are the focus, it is important to understand that anyone who suffered from a traumatic injury, such as whiplash in a car accident or sports injury, or someone suffering from degenerative problems of the neck, blurred, double vision is only one component of symptoms. Fixing the problems of blurred vision will be difficult to treat when symptoms of cervical neck instability is not treated. We will provide treatment options below.
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 (1) of the most difficult to treat and manage visual disturbances in their patients with neck pain.
- The most prevalent symptoms that they found in the patients of the study were:
- ‘patient found that they had to concentrate to read‘ (70%) and
- ‘patient found that they had sensitivity to light‘ (58.6%).
- Lesser prevalent but still impacting many patients were:
- double vision (28.6%) and
- ‘dizzy reading‘ (38.6%).
- The most troublesome symptoms were
- ‘need to concentrate to read’
- ‘visual fatigue’
- ‘difficulty judging distances’
- 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, Ph.D., 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 (2) 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.
Altered cervical joint position. 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 concussion, whiplash, and sports injury who suffer from these various problems including double vision and other vision problems. But as pointed out in this article, we also see patients with the same symptoms who suffer from cervical degenerative disc disease. What both challenges have in common is that the cervical vertebrae are hypermobile and are moving in and out of their natural position.
Whiplash and cervical ligament damage – can this be the cause of your double, blurry vision?
In a new 2019 study, researchers at the The University of Queensland published their findings in PM & R : the Journal of Injury, Function, and Rehabilitation,(3) that suggests that people with whiplash-associated disorders who have difficulty with quick head movements and cervico-ocular dysfunctions, should be evaluated for changes in coordination between eye movement and neck muscle activity.
- In other words, something is off between the patient’s eye movements and the patient’s neck muscle movements. (Watch the video above) There is a break in the connection between how your head turns and how your eyes focus. In many patients, we see the break as cervical instability.
It is interesting to note that the research above also suggests that this problem with the neck muscles should be explored because not only is there a connection to vision problems, but, “Contrasting (new) changes are present in deep and superficial neck muscles with implications for neck function that may explain some common WAD symptoms.” If the muscle problem is affecting vision, it is affecting other symptoms as well.
In the journal Physical Therapy, researchers led by the Erasmus University Medical Center in the Netherlands showed the cervico-ocular reflex could be altered in non-traumatic neck pain patients.(4)
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 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).”
Problems of neck stability and movement caused by muscle atrophy. Can muscle atrophy cause double, blurry vision?
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.
The case of the baseball player with double vision and migraines. It was a tendon.
Above we spoke about muscle atrophy causing problems in the neck leading to double, blurry vision. Tendons are strong bands of connective tissue. They connect the muscles to the bone. When a tendon is damaged, the muscles do not get the needed resistance or pull to stay strong. They atrophy. They also cause instability in the neck and problems related to cervical instability including double, blurry vision.
In April 2018, the New York Yankees placed Brandon Drury on the Disabled List with migraine headaches and more troubling to the team and player, blurred and double vision. As reported by nj.com’s Brendan Kuty | NJ Advance Media for NJ.com Drury said:
- “It’s something I’ve been battling for a while. (The cure is) not going to happen overnight but hopefully, with all the stuff we’re doing we can figure it out and I can get back out there.”
Wrote Kuty: “Drury said the headaches and vision problems have been a problem for quite some time, but he hinted that they’ve been also been a constant. Drury said the pain comes when he ramps up his physical activity. Doctors have prescribed an anti-inflammatory to Drury. . . He added that he’s still undergoing tests and that he’s awaiting results from other test.”
It was soon determined that Drury was suffering from an irritated tendon that ran from his neck to his head.
On April 21, 2018, Bryan Hoch of MLB.com reported on Drury’s progress:
Drury has been on the disabled list since April 7 with the issue, which he said has affected him throughout his career, though he did not disclose it to the D-backs (his previous team the Arizona Diamondbacks) during his previous three big league seasons, and the Yankees say they were unaware of it prior to his February acquisition. While Drury said he is still experiencing migraines, the blurred vision has dissipated.
- “I’m figuring out what’s going on, so it’s good,” Drury said. “We’ve been doing a lot of work in the back of my neck area. I’m not sure if that’s what was causing this, but there was a lot of pressure back there. We’re trying to release that.”
Brandon Drury did return to the Yankees after team doctors were able to identify that the blurred vision and the migraines were seemingly caused by an irritated tendon which likely caused problems in the muscles of the neck and muscle spasms which can be one of the tell-tale causes of migraines and vision problems. It was an MRI that showed an inflamed tendon.
Our treatments for cervical instability and related challenges of vision
Regenerative Medicine Injections | Caring Cervical Realignment Therapy
Prolotherapy is an injection technique that stimulates repair of unstable, torn, or damaged ligaments. When the cervical ligaments are unstable, they allow for excessive movement of the vertebrae, which can stress tendons, atrophy muscles, pinch on nerves and cause other symptoms associated with cervical instability including problems of vision.
Treating cervical ligaments – published research from Caring Medical
In 2014, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments in The Open Orthopaedics Journal.(5) We are honored that this research has been used in at least 6 other medical research papers by different authors exploring our treatments and findings and cited, according to Google Scholar, in more than 40 articles. In this research we suggested that:
- In the upper cervical spine (C0-C2), this can cause symptoms such as nerve and tendon irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, migraine headaches and vision problems.
Treating and stabilizing the cervical ligaments can alleviate the vision problems by preventing excessive abnormal vertebrae movement, the development or advancing of cervical osteoarthritis, and the myriad of problematic symptoms they cause.
An introduction to the treatment is best observed in the video below. A patient with cervical neck instability is treated with Prolotherapy using a Digital Motion X-ray machine.
Caring Cervical Realignment Therapy (CCRT) was developed by Ross Hauser, M.D. after decades of treating patients with neck disorders, including cervical instability and degenerative disc disease
As we discussed in the research above, our goal is to provide long-term solutions to the problems and symptoms of chronic neck pain and instability such as headaches, dizziness, double/blurred vision, vertigo, lightheadedness, imbalance and a host of other symptoms attributed to neck injuries.
Caring Cervical Realignment Therapy combines individualized protocols to objectively document cervical spinal instability, strengthen weakened ligament tissue that connects vertebrae, and re-establish normal biomechanics and encourages the restoration of lordosis. This is our treatment method of moving towards putting a patient’s cervical spine back into place.
For many years, Dr. Hauser and the Prolotherapists at Caring Medical have had tremendous success in treating patients who were suffering from chronic neck pain. Though most of the cases were already failures in the traditional pain management system, Dr. Hauser’s team was able to help the majority of these tough pain cases.
Through extensive research and patient data analysis, it became clear that in order for patients to obtain long-term cures (approximately 90% relief of symptoms) the re-establishment of some lordosis, (the natural cervical spinal curve) in their cervical spine is necessary. Once spinal stabilization was achieved with Prolotherapy and the normalization of cervical forces by restoring some lordosis, lasting relief of symptoms was highly probable.
If this article has helped you understand the problems of double, blurred vision and you would like to explore Prolotherapy as a possible remedy, ask for help and information from our specialists
1 Treleaven J, Takasaki H. Characteristics of visual disturbances reported by subjects with neck pain. Manual therapy. 2014 Jun 1;19(3):203-7. [Google Scholar]
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. [Google Scholar]
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. [Google Scholar]
4 Bexander CS, Hodges PW. Cervical rotator muscle activity with eye movement at different speeds is distorted in whiplash. PM&R. 2019 Jan. [Google Scholar]
5 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]