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.
- Do you have questions about vision problems and chronic neck pain? You can get help and information from our Caring Medical Staff
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.
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. (1)
Can a herniated disc in the neck cause blurred vision?
In our office 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 the cervico-ocular reflex could be altered in non-traumatic neck pain patients.(2)
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 were 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 reduce 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 patients 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:
Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability
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;8:326-345.
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain.
The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome.
When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability.
Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability...
The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study
Ross Hauser, MD, Steilen-Matias D, Gordin K. The biology of prolotherapy and its application in clinical cervical spine instability and chronic neck pain: a retrospective study. European Journal of Preventive Medicine. 2015;3(4):85-102.
Background: In an effort to facilitate the diagnosis and treatment of clinical cervical spine instability (CCSI) and chronic neck pain, we investigated the role of proliferative injection Prolotherapy in the reduction of pain and recovery of constitutional and neurological symptoms associated with increased intervertebral motion, structural deformity and irritation of nerve roots.
Methods: For this retrospective case series, 21 study participants were selected from patients seen for the primary complaint of cervicalgia. Following a series of proliferative injections, performed in a private sub-specialty pain clinic, patient- reported assessments were measured using questionnaire data, including range of motion (ROM), crunching, stiffness, pain level, numbness, and exercise ability, between 1 and 39 months post-treatment (mean = 24 months). All patients signed a consent form prior to treatment.
Results: 95 percent of patients reported that Prolotherapy met their expectations in regards to pain relief and functionality. Significant reductions in pain at rest, during normal activity, and during exercise were reported. A mean of 86 percent of patients reported overall sustained improvement, while 33 percent reported complete functional recovery. 31 percent of patients reported complete relief of all recorded symptoms. No adverse events were reported.
Conclusion: The results of this study demonstrate statistically significant reductions in pain and functionality, indicating the safety and viability of Prolotherapy for cervical spine instability. Such clinical efficacy of this procedure warrants further investigation as a non- invasive treatment option.
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 here 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. Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jun 16(0):1-25.
2. 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.