Exercises for Eyes and Body for Chronic Neck Pain and/or Cervicogenic Headache

https://www.youtube.com/watch?list=PLKLMY4-61En-tREwn7rFC8ZCWYBfaPBo0&v=ECh-V0ZxeZE

The body has an amazing connection between the eyes and neck whereby dysfunction in either area can result in pain and/or dysfunction in the other respective region. Also, if the eyes or neck are misbehaving, it is common to also have symptoms of jaw (TMJ), upper back, shoulder and/or scapular pain/ stiffness/ instability/ decreased ranges of motion. For the sake of brevity, this article will focus primarily on how we can train the eye muscles and the proprioception (our body's sense of where its part is in space and related to other parts of our body) and neck muscle to work in harmony. It appears that chronic neck pain, headache, or both can have root issue in lack of eye muscle function and the ability of the eye movement to work with (not against) the muscle of the neck.

The brain and other parts of our central nervous system have a sort of "safe-mode" whereby our muscles and joints will default if poor proprioception and stability is sensed. For those who have had a care go into "limp mode" before, the following example will make perfect sense. Some models of cars will go into "limp mode" when it losses sensor input into the car's computer system; the car doesn't know exactly how much fuel or air the engine is getting or how much oil pressure. The car's mechanics may be perfectly fine, the car could be running properly, but the computer does not recognize or can confirm the data. Hence, "limp mode" is initiated, the car will limit the top speed, engine RPMs, and other performance in effort to protect the health or integrity of itself until it can be diagnosed by a mechanic.

Likewise, our bodies behave in effort to protect itself. We've all witness this before whenever we begin to slip when walking across ice or something slick. We immediately revert to becoming stiff, try to bring our arms and legs closer to midline because our body doesn't know precisely where it is in space. Hence, when we lack accurate sensation of self-awareness or if our body perceives itself weak in a certain position, the default "limp mode" of our body is to protect itself, limiting our range of motion and tensing up muscles by co-contraction. While this phenomenon is great for self-protection if we are about to fall, or encounter some form of trauma, it unfortunately can be a cause of chronic pain, decreased flexibility and function if we are in a constant state of sensory (proprioception) malfunction.

We don't have to be broken/ damaged to have pain or stiffness in the neck or have chronic headaches. It can likely be a result of the body's loss of proprioception, and we can remedy it with novel exercises. Most of us know "if you don't use it, you lose it" as it applies to bodily flexibility, strength, and fitness. I believe the same is true when it comes loss of eye and neck musculature harmony. If you look at babies and kids, they first learn to look with their eyes, then coordinate the eye muscles with the neck and rest of the body.

A randomized controlled trial by Abdel-Aal et al. (2024) found that superior improvements in chronic neck pain was accomplished by 4 weeks of eye and neck proprioception and muscle training. The researchers used isolated eye movements, isolated neck movements, and the coordinated neck + eye movements. Results were an impressive pain QVAS score from 79% to 27% and 72% improvement in their "neck disability index" scores in only 4 weeks!

Hence, check out my video on some of these exercises used in the study. My recommendation is to perform all of these at least 3x/ week as was done in the research study. If you get a significant increase in neck pain and/or headache while performing one of these exercises. reduced the number of reps/ time or reduce the ROM (range of motion) in which you are performing them. The same applies if you experience nausea.

To progress these exercises, you can try performing some of them with one eye covered. This can be especially helpful if you know you have a "lazy eye" or get neck pain or headache when reading or having to focus up close for extended periods of time.

Have fun with these! It's not rocket science, it is simply getting your eyes, neck, and body to understand how to work together again. Please be sure to check out the article on upper back, neck, and shoulder exercises / mobility work as improving function and fitness in these areas can also do wonders for chronic neck pain and headache.

Try performing these 3-5 times per week and see how you feel by week 4!

EXERCISE NAME	PROCEDURE	REPS/ SETS/ TIME
Oculomotor muscle activation	Seated with head and body stationary Perform max eye ROM in 8 quadrants	Hold each end range 2 seconds 3 rounds with eye open 3 rounds with eyes close
Passive Cervical Spine ROM with eyes fixed	Seated while assistant moves head in 6 directions while patient maintains eyes fixed on set object ·       Lateral flexions ·       Extension ·       Flexion ·       Rotations
Multi-directional convergence/ divergence	Seated, head neutral Move at 1cm/ sec 8 directions Progression: trunk rotated left and trunk rotated right	Have fun! No set directions.  Performed 1-2 rounds 3-5x/ day
Active Cervical Spine ROM with eyes fixed	Seated while moving head/neck into 6 directions while eyes kept fixed on object ·       Lateral flexions ·       Extension ·       Flexion ·       Rotations	Hold each position 10 seconds at end range 3 rounds
Coordinated eye-neck ROM (aka "check your mirrors, check your kids")	Seated on stationary surface while following an object while moving both eyes and neck in multiple directions ·       Looking up/ down while keeping torso stationary. Progression to unstable surface	Have fun! No set directions
Standing trunk rotations with gaze fixation	Stand on stationary or progress to unstable surface while keeping eyes fixed on object. Rotate body left/ right Unstable/ balance surface or perturbations provided by an assistant.	Have fun! No set directions
Head Reposition (1st degree)	Seated in front of a mirror with assistant bracing shoulders to limit movement to the cervical spine. “Memorize” neutral head position. Then close eyes, move neck in all 6 cardinal ROM’s then return to neutral.	Perform 3 rounds the reopen eyes. Or can re open eyes after 1 round and repeat 2x
Head Reposition (2nd degree)	Seated on unstable surface (bosu ball/ med ball/ balance pad) or have assistant add perturbations to the torso. Same instructions as Head Reposition 1st degree	Same as above
Free Coordination gaze fixation	Seated on stable surface. Assistant stands in front of patient as their eyes, neck, torso are allowed to move freely in large amplitude/ max ROM Object is moved into 8 cardinal directions (up/ down/ left/ right/ up-right/ up-left/ down-right/ down-left	Perform 2 rounds
Manual resistance neck coordination exercise	Patient seated Assistance applies resistance as patient performs cervical movements in all directions. Return to neutral position after each direction	Have fun! No set instructions
Head shakes for gaze fixation and vestibular proprioception	Seated or standing on stable surface with eyes fixed on pen tip at arms length Perform 10-20 shakes in each head position (left/right; up/down; diagonally (both directions)	Perform 1-2 rounds 2-5x/ day

References:

Abdel-Aal, Nabil & ElKeblawy, Maher & Amine, Randa. (2024). Effectiveness of eye-cervical re-education versus motor imagery therapy on chronic neck pain: A randomized controlled trial. SPORT TK-Revista EuroAmericana de Ciencias del Deporte. 6. 10.6018/sportk.605711.