Look Again: Are your Eyes hiding clues to solving your Neck and Back Issues?

How Your Eyes Can Contribute to Neck and Upper Back Pain 

When people think about the causes of neck or upper back pain, posture, stress, or muscle tension are usually the first things that come to mind. But one factor that is often overlooked is the role of our eyes and insight they give to your vestibular and nervous system function.   

Your eyes and neck are closely connected. In fact, when your eyes aren’t moving or tracking as smoothly as they should, your body will often compensate for this by moving your head and neck instead, or even not moving your head and neck to limit how much your eyes have to work.  Over time, this repeated compensation can lead to increased muscle strain, stiffness, and even pain. 

 Why Eye Movements Matter  

Healthy vision involves not only clear eyesight, but also smooth and coordinated eye movements, that are controlled by your vestibular and nervous system, specifically cranial nerves (nerves from inside your brain and brainstem). If your eyes have difficulty tracking side to side, up and down, focusing, or maintaining alignment, your brain may unconsciously ask your neck to help or limit how much your neck moves to keep a clear image. This means instead of just moving your eyes to look at something, you might frequently turn or tilt your head or increase the tension in your neck to help stabilize your vision or bring things into focus.  

Everyday Scenarios Where This Happens 

 This pattern is common in many day-to-day activities, such as:  

• Desk work: Constantly turning your head toward a second monitor or straining to look at a screen off to one side. 
• Driving: Rotating your whole head instead of smoothly scanning with your eyes. 
• Watching TV: Sitting at an angle on the couch and turning your head instead of just shifting your eyes. 
• Phone or tablet use: Tilting your head downward for long periods instead of moving just your eyes.
• Walking: in order to safely navigate our surroundings we need a clear view.  Increased tension in your neck may be a compensatory reaction to your eyes not stabilizing and adjusting to your movement.

Over time, these small but repeated adjustments can overload the muscles in your neck, shoulders, and upper back. 

 What Can Be Done  

The good news is that physical therapy can address both the muscular, vestibular and visual components of this problem. By improving posture, retraining how the eyes and neck work together, and addressing muscle imbalances, many people experience relief from pain and improved function. 

 The first step to deterring treatment is to uncover the underlying problems creating the symptoms.  Luckily we have some clinical tests that give us in-sight to the different underlying systems.  

How to Test for Visual Impairments Independently  *Tip: use your phone camera to record yourself, so you can watch how your eyes are moving!

1- Visual tracking and alignment (How well your eyes follow a moving target) 

• How to complete: Hold a pen at arm’s length, without moving your head follow the tip of the pen with your eyes as you move it in a large “H” shape. Complete using both eyes, then cover one eye at a time and complete again. 
• What to look for: Watch for shaky movements, jumping to and from the target, or if one eye drifts away from the other. Smooth, coordinated movements are the goal.

2 – Focusing (near to far) 

• How to complete: hold a pen about 6 inches from your nose in one hand. You will also be holding a pen in the other hand; this arm will be fully outstretched in front of you and placed just off to the side. Look at the pen closest to you until it becomes clear, then switch your focus to the further pen until it becomes clear. Repeat. 
• What to look for: Notice how long it takes for each object to come into clear focus. Difficulty or feeling of strain could be a sign of weak eye muscles. 

 3 – Convergence (eyes working together) 

• How to complete: hold a pen with a fully outstretched arm. Slowly bring the pen closer to your nose, keeping your eyes fixed on it. 
• What to look for: Stop moving the pen closer to your face once you see seeing double of the pen, or the pen becomes blurry. If the pen is further than about 3 inches from your face when you start seeing double, your eyes may not be working together as they should. 

 4 – VOR Test: Gaze Stability Check

• Purpose: Assess how well your eyes stay focused on a target while your head moves—a key function of the vestibular system.
• How to complete: Sit or stand facing a blank wall. Hold a thumb or pen at eye level about 3 feet away, or place an “X” on the wall. Keep your eyes fixed on the target. Turn your head side to side (left to right) at a steady pace—about one turn per second—for 30 seconds. Repeat with up-and-down head movements.
• What to Look For:  Blurry vision or dizziness during movement, Difficulty keeping eyes locked on the target, Nausea or imbalance may indicate vestibular dysfunction

 Try These Simple Eye and Neck Exercises 

 Here are a few gentle strategies you can try to help your eyes and neck work more efficiently together. 

For all of them start out sitting and once they get easier, progress to standing, staggered standing and then if you get real ambitious, do them on 1 leg!  

️Smooth Pursuit Drill: “Follow the Target”

Purpose: Enhance smooth, coordinated eye movements without head involvement.

Setup:

• Use a pen, finger, or small object as a visual target.
• Sit or stand comfortably in a quiet space.
• Keep your head still—use a mirror or phone camera to monitor.

Instructions:

1. Hold the target at arm’s length directly in front of your face.
2. Slowly move the target horizontally (side to side) while keeping your eyes fixed on it.
3. Repeat the movement vertically (up and down).
4. Optional: Add diagonal movements or slow circles for variety.
5. Perform each direction for 20–30 seconds, 2–3 times per day.

• Benefits: Boosts eye coordination and tracking; Reduces neck and shoulder strain from overcompensation;  Enhances focus for reading, driving, and screen use; Supports balance and vestibular function; Aids visual processing and attention

️Near–Far Focus Drill: “Thumb & Target Switch”

Purpose: Strengthen the eye muscles responsible for shifting focus between near and distant objects.

Setup:

• Sit or stand comfortably.
• Hold your thumb (or a pen) about 12 inches from your face.
• Choose a distant object across the room (e.g., a picture frame, clock, or light switch).

Instructions:

1. Focus on your thumb for 3–5 seconds until it becomes clear.
2. Shift your gaze to the distant object and hold focus for 3–5 seconds.
3. Continue switching back and forth for 1–2 minutes.
4. Keep your head still—only your eyes should move.

This drill helps retrain your visual system to adapt smoothly between distances, reducing the tendency to overuse neck movement during tasks like reading, driving, or desk work.

Visual Saccades Drill: “Target Switch”

Purpose: Improve rapid eye movement between two points without moving the head.

Setup:

• Place two visual targets (e.g., sticky notes, letters, or colored dots) about 10–12 inches apart on a wall at eye level.
• Stand or sit about 3 feet away from the wall.

Instructions:

1. Keep your head completely still.
2. Rapidly shift your gaze from one target to the other and back again.
3. Perform for 20–30 seconds.
4. Repeat in different directions:
   • Horizontal (side to side)
   • Vertical (up and down)
   • Diagonal (top left to bottom right, and vice versa)

This drill is great for patients who overuse neck movement during visual tasks like reading, driving, or screen time

Neck & Shoulder Reset 

• Sit tall in your chair. 
• Gently retract your chin (think “making a double chin”), hold for 5 seconds, and release. 
• Roll your shoulders up, back, and down. 
• Repeat 8–10 times every hour you spend at a desk 

Thoracic Rotation Reset (Desk-Friendly Version)

• Sit tall in a chair with feet flat and spine upright.
• Cross your arms over your chest or place hands behind your head (will be more intense with hands behind your head).
• Rotate your torso slowly to the right, keeping hips and legs still.
• Pause for a breath, then return to center.
• Repeat to the left.
• Perform 5–8 reps each side, 2–3 times per day.

Tip: Let your eyes follow the movement to reinforce eye-neck coordination.

 

Final Thoughts: Don’t Overlook Your Eyes

Neck and upper back pain aren’t always about posture alone—your eyes, nervous system and vestibular system play a bigger role than most people realize. If you’ve been stretching, adjusting your chair, or working on your posture without lasting relief, it might be time to look a little higher… literally.

Try the simple eye and neck exercises above for a couple of weeks and see how your body responds. These small changes can make a big difference in how you feel day to day.

Still feeling stuck or unsure? We’re here to help. Schedule an evaluation and let’s work together to get your eyes, neck, and posture back in sync—so you can move through your day with less pain and more confidence.