Car­la Rauseo

I sup­pose it does sound strange when you first hear it...spec­ta­cles caus­ing neck pain? But it all be­gins to make sense when one un­der­stands how our eye-glass­es can af­fect the neck.

The in­spi­ra­tion for this top­ic came af­ter a re­cent ex­pe­ri­ence I had at an op­ti­cal store. Be­ing due for my an­nu­al check-up, and re­plen­ish­ment of my sup­ply of con­tact lens­es, which I con­sid­er one of the best in­ven­tions in the uni­verse, I made an ap­point­ment.

First, I was test­ed for glau­co­ma with what I call the "puff test." I de­test this screen as I must place my chin on­to the chin rest of a ma­chine and hold still while a jet of air is eject­ed in­to my eye with­out warn­ing. "Sur­prise!" But be­sides the un­ex­pect­ed jet of air, what adds to the un­pleas­ant na­ture of the test is the fact that the ma­chine or chair is sel­dom ad­just­ed for my height. I must there­fore slouch for­ward and pro­trude my head like a tur­tle for it to reach the chin rest. This same is­sue aris­es when be­ing test­ed by the op­tometrist on oth­er equip­ment.

This poor po­si­tion­ing, known as for­ward head pos­ture, is a po­si­tion of stress for the neck. It can ex­ac­er­bate symp­toms in those with cer­vi­cal is­sues, and en­cour­age the de­vel­op­ment of pain in non-symp­to­matic in­di­vid­u­als.

But at least this sit­u­a­tion on­ly hap­pens once, maybe twice a year, when I go to get my eyes test­ed. The re­al prob­lem is my spec­ta­cles and the way many of the op­ti­cians ad­just them.

Hav­ing a large, play­ful dog who is for­ev­er knock­ing my spec­ta­cles, I am a fre­quent fly­er at the op­ti­cian's desk for read­just­ment. All goes well un­til he re­places them on my face and then asks me to lift my chin. I as­sume he asks this so he can get a di­rect, head-on view of my face in or­der to as­sess the fit­ting of the spec­ta­cles.

How­ev­er, lift­ing the chin ac­tu­al­ly puts the neck in­to ex­ten­sion, so the pa­tient is ac­tu­al­ly look­ing slight­ly up­wards and is in a for­ward head pos­ture. The op­ti­cian does not get a true head-on view of the pa­tient's face and is at risk of ad­just­ing the spec­ta­cles too low on the pa­tient. This is ex­act­ly what hap­pened to me re­cent­ly. With my glass­es too low on my face, I had to tilt my head slight­ly up­wards, and ad­just my eyes to look slight­ly down­wards so that I could see straight ahead and in­to my glass­es...like the old granny read­ing the din­ner menu. This kind of head po­si­tion is a typ­i­cal pre­cur­sor to neck pain and one I preach against as a phys­i­cal ther­a­pist. Need­less to say, when I re­alised the er­ror in the op­ti­cian's ad­just­ment, I marched right back to his desk the next day!

I am no ex­pert on the fit­ting of glass­es. How­ev­er, I feel that op­ti­cians should in­struct pa­tients to sit straight and avoid slouch­ing in or­der to get a more ac­cu­rate head-on view of the pa­tient's head, not to lift the chin. I can con­fi­dent­ly say that 95 per cent of the pop­u­la­tion slouch­es, and this is a ma­jor con­trib­u­tor to neck pain.

It works like this. If one slouch­es with­out ad­just­ing the head up­wards, one will see ob­jects on the floor and not straight ahead. There­fore, a slight up­ward tilt of the head is nec­es­sary in or­der to com­pen­sate for this slouched pos­ture. How­ev­er, in this new po­si­tion, if the eyes are not read­just­ed, one will be look­ing up­ward, as the head is tilt­ed up­ward. The pa­tient must there­fore now ad­just his/her line of sight down­wards in or­der to look straight ahead. Over time, this for­ward head po­si­tion be­comes learned as nor­mal to the in­di­vid­ual, and is an ex­treme­ly dif­fi­cult habit to cor­rect. It of­ten re­sults in neck pain as the po­si­tion weak­ens im­por­tant mus­cles, tight­ens oth­ers, and places small but cu­mu­la­tive stress­es on the spine and sur­round­ing mus­cles.

Poor­ly ad­just­ed glass­es al­ter the po­si­tion of the head in the same way. Bi­fo­cals and pro­gres­sive lens­es are al­so well-known cul­prits, as the wear­er must con­stant­ly ad­just the po­si­tion of the head and of­ten as­sume a for­ward head pos­ture in or­der to see through the spec­ta­cles. The ef­fect is wors­ened if per­formed on top of poor pos­ture.

The eyes and the neck are in­tri­cate­ly con­nect­ed. We make un­con­scious ad­just­ments to our sight in re­sponse to sub­tle neck move­ments, and vice ver­sa. It is called cer­vi­cal-oc­cu­lar co-or­di­na­tion. Un­for­tu­nate­ly, we re­ly so much on our eye­sight that we fail to feel and un­der­stand the po­si­tion of the head and neck, and spend most of our time in po­si­tions of cer­vi­cal stress. Just look around. The for­ward head pos­ture has be­come so com­mon, it now looks nor­mal!

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