https://www.youtube.com/shorts/8A1YBq1lGnI

With around 70% of the US workforce using a computer for part or most of a typical workday, ( not even considering screen time outside of work), the number of patients reporting neck pain and muscle dysfunction when using an electronic device is sky high. Most patients attribute the connection to the postural strain of neck / shoulder position when facing a screen. In this blog I want to explore another mechanism by which using a computer screen can create neck symptoms.

From a neurological perspective, there is an anatomical connection in our brainstem between the neurons controlling eye movements and those controlling fine neck movement. It is an oversimplification of some complex neural pathways whose job it is to coordinate your head movement with your eye movements so that you can keep your gaze fixed on a target while either your neck or trunk are moving , or your target is moving.

If your target is moving, you need to fix your gaze on that target by moving your intrinsic eye muscles, and either moving your neck in tandem with your eyes if the target moves beyond the field of vision, or fire up the deep intrinsic neck muscles to hold your neck in place, such as is the case when looking at a computer screen.

If your neck and trunk are moving while you are keeping your gaze fixed on a target, your eye muscles have to adjust by constantly coordinating with the position sensors, primarily in your cervical facets ( a less common scenario in daily life)

If all goes well with the neurological circuit, it will be a silent background process that you will never concern yourself with. But for some of you, it does not go well, and by now I have your attention.

The two symptoms you are most likely to experience with a lack of proper coordination between your visual and cervical control system look like this:

gradually worsening sensation of neck tightness when looking at a screen, or reading a book, regardless of the ergonomics of your set up. Especially if the screen is displaying rapidly moving multiple targets ( video games, action movie), or scrolling. Not responding to muscle therapies.
gradually worsening eye pain, headaches behind or around the eye, when doing the same activities as above. It will often be much worse on one side. Not improved by glasses and no abnormalities detected on optometry exams.

Why does the cervico-ocular reflex gets disrupted ?

The system can be functionally injured primarily via either head injuries or cervical injuries ( whiplash type injuries being the most common mechanism, as described in the research article below). It is helpful to differentiate the mechanism of injury to direct the rehab to the right structure.. For primary visual control injuries, as is very common with even mild TBI, very slow progressive visual exercises are needed. For primary cervical injuries, traditional proprioceptive retraining of the cervical facets will reestablish a proper cervico ocular reflex loop

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1284-4