Behind the Eyes

While experimenting with my students recently in clinic, a patient reported with complaints of T-Spine pain rated 3/10 at rest with no significant aggravating factors, limited multisegmental trunk rotation bilaterally with right greater than left, and a very strange presentation of bilateral weight bearing shoulder stability and motor control dysfunction (SMCD). While evaluating multisegmental rotation we noted that the patient did not initiate the motion with the head, choosing a movement strategy that kept the head rather stable rotating the trunk 'underneath' the cranium. When cued to lead with the head/eyes, the patient's pain reduced (2/10) and multisegmental rotation improved.

The patient had reported a fall several months early landing on her head with no immediate pain or loss of function outside of mild (3/10) intermittent pain in the area of T6-T9. The shoulder SMCD was only evident if the patient stood with 'perfect poster' protracting and downwardly rotating the scapula. In a 'normal' standing (certainly not pathological) posture, the patient had full, pain free bilateral shoulder flexion AROM. When 'postured up' the patient was reduced to less than 90 degrees of bilateral shoulder flexion AROM. Due to the patient's potential MOI I began exploring the relationship between cervical spine/C-T junction rotation and active shoulder AROM in this 'postured up' position. With R cervical rotation, active shoulder flexion increased to roughly 130 degrees with no reduction in T-Spine pain (3/10). Left cervical rotation positively affected active shoulder flexion bilaterally to about 100 degrees (minimal).

Based on our multisegmental rotation observations we then began to explore how eye movement might influence pain and shoulder AROM. Oddly, the patient's results were reversed when compared to cervical rotation with looking to the left (eye movement) increasing the patient's shoulder AROM to a pain free 180 degrees. Looking to the right (eye movement) produced results though they were far less successful than left directional eye movement. Based on a previous experience, documented in an earlier blog entry, I chose to explore how Total Motion Release might change this patient’s function and pain. We asked the patient to look to their left with only their eyes, 10 times, retesting after this first set. The patient restored nearly full AROM bilaterally regardless of the direction of their gaze (up, down, left, or right). We then asked the patient to complete looking to their left with only their eyes 20 more times in sets of 10. After completing this, the patient reported 0/10 pain in the T-Spine area of chief complaint, had restored bilateral shoulder flexion AROM to 180 degrees regardless of gaze direction, and had fully restored shoulder flexion with cervical rotation. The patient had also restored multisegmental spinal rotation and was freely using their gaze and cervical rotation to lead the motion. 24 and 48 hours later the patient had maintained all reported results.I have to imagine this has something to do with cranial nerves II, III, IV, V, VI, X and perhaps XI.