What is the connection between back, neck, and eye pain?

How are your eyes, neck and back connected?

If you have ever experienced eye strain and discomfort at the same time as neck or upper back pain, you may have wondered how these areas are linked.

Muscle tension in your neck and back can't directly cause eye problems and discomfort - or the other way around. However, having eye and back pain together could be a sign that certain activities or actions are causing your discomfort in all of these areas.

There are also a few health issues where discomfort in one area may be triggered by a problem with the other. In other words, neck and back pain can be symptomatic of an eye problem. Likewise, eye discomfort - in the form of mal di testa around the eye area - can point to neck and back issues.

Many of the activities that cause eye strain and discomfort also lead to neck and back problems. Eye strain is extremely common and occurs when your eyes become tired from intense use. You may also feel eye discomfort in the form of dry eyes or having vision that goes slightly blurry every so often. These same activities often promote poor posture in your neck and back, which in turn can cause muscle tension and pain in these areas.

Many of these activities involve visually demanding near work - which means any activity performed at a short working distance¹. Examples of near work include:

• Reading.

• Writing.

• Playing video games.

• Needlework.

But there is little doubt that in modern life, the most significant example is digital display use - when we stare at our mobile, laptop, or ipad screens. Digital eye strain, also called computer vision syndrome, is a common cause of both eye and back pain.

Long periods of close-up work can result in eye strain, because it involves us staring intensely and positioning ourselves near to the screen/book/paper/needlework - which leads to poor posture².

There are several eye problems that may also be indirectly connected with your back and neck pain.

Binocular vision dysfunction

Binocular vision dysfunction (BVD) is a common visual misalignment condition. The eyes struggle to send a clear image to the brain because they are slightly misaligned. There are many symptoms, but the main visual signs include blurred vision, light sensitivity, and eye discomfort when moving.

BVD can also cause shoulder and neck pain. This is because the visual misalignment causes muscle tension, which is made worse for people who compensate by tilting their heads towards one shoulder. This may help to realign the images vertically, but this is a dangerous habit that can lead to ongoing neck pain.

Long sightedness

If you are long-sighted (hypermetropia) you can see objects in the distance clearly while objects nearby are out of focus. This makes it difficult for the eye to focus light on to the correct part of the retina.

As a result, without prescription eyeglasses or contact lenses, long-sighted people tend to strain their eyes in an attempt to improve focus. It's possible that attempting to move closer or further away from the object results in bad posture habits, making the pain worse.

Presbyopia

Presbyopia is age-related long-sightedness. To see objects clearly at different distances, the eye's lens needs flexibility. Naturally with age, this flexibility decreases, and lenses become stiffer. Like hypermetropia, if left untreated this can cause both eye and back pain.

Leanne Antoine, physiotherapist and spokesperson for the Chartered Society of Physiotherapy (CSP), advises that muscle tension in your neck and back can also indirectly result in eye pain.

This happens when you unconsciously tense the muscles in your neck, upper back, and shoulders. This leads to tension in the back of the skull - the occipital area - causing mal di testa that affect the area around your eye.

Muscle tension in the back and neck can be triggered by many things. Physiotherapists can help you find the cause of your pain and offer a tailored physiotherapy service to relieve the tension.

Cervicogenic headaches

"As physiotherapists it is important that we establish the primary cause of your muscle tension. But, if you have eye pain, you may also have a secondary mal di testa which is called a cervicogenic headache (CGH)," explains Antoine.

"This headache starts in the cervical spine - your neck - and is characterised by neck pain and stiffness which may well be accompanied by muscle tension."

CGH symptoms usually occur on just one side of your neck, head, and/or face and commonly affect the area around the eye. This headache is usually a moderate, dull ache but can be more intense. In some cases, it can also result in eye swelling and blurred vision.

Antoine adds: "There is also a school of thought that if certain structures in the upper part of the neck are injured or damaged in some way, that damage can create more sensitivity, leading to this type of headache."

1. Zetterberg et al: Neck/shoulder discomfort due to visually demanding experimental near work is influenced by previous neck pain, task duration, astigmatism, internal eye discomfort and accommodation.

2. Zetterberg et al: Trapezius muscle activity increases during near work activity regardless of accommodation/vergence demand level.

3. Maducdoc et al: Visual consequences of electronic reader use: a pilot study.

4. Coles-Brennan et al: Management of digital eye strain.

5. Randolph: Computer vision syndrome.