When people come to see me to reduce pain in the body and as a result be able to do more, I will always assess their vision. Inevitably I will find that one or both of their eyes are not working as well as possible and will set an eye exercise to improve vision and therefore reduce their pain – which is clear to me but a total mystery to them. Because as yet we are not used to thinking in the big picture, me setting an eye exercise causes confusion – ‘Why waste time exercising my eyes? The pain is in my back/neck/knees/hip/foot.’
So here is an explanation of why vision matters.
The brain is a lump of grey matter sitting inside a bony box. As such, it knows nothing of the world outside. It gets its information through the eyes, the inner ears and the body. Which means it sees things using two sorts of vision: focussed – whatever we are actually looking at, and peripheral – the stuff that we see around the area of focus. The inner ears let the brain know whether our head is turned or tilted so we can stop ourselves falling over. The body tells the brain where our limbs are in space, what our spine is doing, how tight or loose our muscles are and it tells the brain about pains, in the body, heat, cold, pressure and so on.
The brain is wired for survival – that is the only thing the brain is interested in. It is not interested in rehab or running faster; it needs to know will I survive right now? And to keep us alive, it will do whatever that takes. The choices it makes are based on predictions.
An example of prediction: picking something up: we want to drink that nice cup of tea; we reach out, hold the handle and lift the cup to our lips. The brain predicts how heavy the cup will be and directs the muscles to contract as much as they need to to pick up the cup smoothly and carry it to our lips; if it couldn’t do that we’d either drop the cup or throw the tea all over ourselves.
It also predicts where the cup is – each eye has an optic nerve at the back of the eyeball that conveys information to the brain. This means that in our vision we have two areas where we can see nothing at all – the area of the optic nerve – and the brain fills the blank bit in from the rest of the information coming from the eyes. Personally I find this fact alone quite mind boggling. Anyway, to pick up the cup, you see the cup either in your direct vision or in your peripheral vision if you are looking elsewhere whilst having a nice cup of tea, and the brain is partly seeing and partly predicting where in space that cup is. Sometimes the prediction goes wrong, especially when not looking at the cup directly; occasionally we reach out for the cup and knock it over since it isn’t quite where we thought it was. Oops.
When it gets hard to predict we slow down: think of driving the car; in good light we whizz along normally; when it’s foggy or driving rain, we slow down because we can’t see the road in front so clearly. And so it is in the body, but more subtley. Walk along a rough path in good light and we stride along, walk that same path in the dark and it’s a very different story. If we actually do stumble, we go even more carefully and generally stiffen up, reaching out our hands to feel and putting down our feet gingerly. We are wired to survive and not fall over and break something, so the brain slows us down, puts us on alert and generally does all it can to get us out of that situation in one piece; because we can’t see clearly, we can neither predict what is directly ahead, nor, if it is a spooky night, what dreadful beast of the night is coming to eat us up. Sounds silly until you really are in a dark wood….
If you still don’t believe me, try striding about your house with your eyes shut or in very, very dark sunglasses. All is fine until you bump into something. Then, if you concentrate, you’ll feel yourself stiffen up as you start to move far more cautiously.
And so as vision degrades, we start to slow down and stiffen up. This is much more subtle than the above example. But to move confidently and speedily through the world, the brain needs to see it, and the more clearly it does that, the lower the danger level perceived by the brain.
This stiffening up is where pain can come in: like water following the easiest course, any muscle that is not working as well as it should – it may be stiff or weak or not working at all – will get much worse and pain will result. And that pain will not properly go away, no matter how many treatments we go for.
Signs that the eyes are not working properly include: wearing glasses; difficulty driving in the dark; chronic pain that will not go away; poor balance; the eyes getting tired at the end of the day; sensitivity to light; headaches; dry eyes; twitching eye lid.
How to tell if your eyes are not working well: video your eyes; first hold a pen up at arms length in front of them and look at the pen; the eyes should be symmetrical.
Then bring the pen in towards the bridge of the nose staring at it; you should be able to touch the nose with the pen and still see one pen – it doesn’t suddenly double – then take the pen away from your nose.
Then follow the pen from side to side and up and down keeping the head still: do this with both eyes and then each eye individually. The eyes should track the pen smoothly and there should be no need to blink.
You don’t have to watch all of this gruesome video, but you’ll get the general idea of what a jerky gaze looks like.
Finally look at something beyond the pen – you should now see two pens.
Now replay the video and watch what your eyes are doing. Then make an appointment with me and we’ll see what we can do to improve things.
I have not talked about the inextricable link between the eyes and the inner ears – both hearing and the balance organs – but if either or both are not working optimally, again we will slow down, stiffen up, get pain and injuries as a result. Yet we only think to look to the site of the pain, not to the causes.
In summary there are three major inputs into the brain: from the body, the eyes and the inner ears. If any or all of those three are not working well, the information going into the brain is a bit rubbish, which means the information about how to move about in the world coming out of the brain can only be a bit rubbish too.