It’s estimated that half of patients with chronic whiplash associated disorders (WAD) will experience vision-related issues such as poor reading concentration, light sensitivity, visual fatigue, and eye strain. Why is this the case, and what can be done for such patients?
Eye movement control depends on the position of the head in space, and head position is determined by the integration of several sub-systems including the vestibular system, the visual system, and the proprioceptive system of the cervical spine. The principal source of cervical afferent (sensory) information arises from mechanoreceptors in the upper cervical spine, especially the deep upper cervical muscles where the density of muscle spindles is extremely high in comparison to other spinal regions.
Because WAD often involves injury to the upper cervical region, sensorimotor control is frequently disturbed, which can affect eye movement control and lead to clinical signs such as nystagmus (oscillating eye movements), dizziness, and balance deficits. There are three distinct eye movement tests utilized when assessing WAD patients: eye stabilization reflexes, smooth pursuit eye movements, and head-eye coordination. Positive findings on these tests could suggest injury in the upper cervical region, which will be confirmed after a comprehensive examination.
Once a diagnosis is established, treatment will often include the application of manual therapies in the clinic along with a home exercise program specific to either the deep and/or superficial cervical muscles.
This is illustrated in a published case study of a 22-year-old female who sustained a concussion and WAD with impaired eye movement control in a high-speed collision. Her treatment started two days post-injury and involved mobilization of the cervical and thoracic spine, manual cervical traction, and soft tissue release techniques. The patient also received training on how to perform deep neck flexor strengthening and eye movement exercises at home. After one clinic visit and four days of the home exercise program (HEP), the patient’s post-concussive symptoms— including dizziness and balance dysfunctions—improved. She continued to experience blurred vision with body rotation as well as reduced cervical ROMs with muscle hypertonicity, both of which resolved after four additional visits over the next two weeks in conjunction with daily exercises.
Several treatment guidelines indicate that chiropractic care is a great first-choice treatment option for the WAD patient, which may involve a multimodal approach to restore normal function to the cervical spine and associated soft tissues.
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