“In fact, 31 million Americans experience low-back pain at any given time…Low back pain is the single leading cause of disability worldwide, per the Global Burden of Disease 2010”. Some other interesting stats are the following; 9 0f 10 people don’t know the primary cause of their back pain. Per the CDC 8 of 10 Americans will suffer from back pain at some point in their lifetime.

Throughout my career I have seen clients that have been to several practitioners yet all they got is temporary relief. This is backed by the stat that 50 billion dollars is spent annually in the USA for back pain treatment. Despite the improvement in technology and exercise protocols many people who are health and fitness clients continue to struggle with chronic back pain. The approach of looking at spinal health as a purely mechanical system has amounted for the most part of people going around in circles and arriving back to chronic back pain. The spine needs to be looked at differently not as a mechanical system but a neuromechanical system.

“Spinal movement is a complex symphony of muscular activation and inhibition combined with the ongoing influences of the spinal structures themselves (vertebrae, ribs etc.), fascial tension planes, dermal adhesions, etc. Most importantly, these structures are in a virtually continuous state of flux and adaptation as we move and are forced to continually re-orient against gravity. Thus, it is a bit naïve and reductionist to always attempt to point to one muscle, one joint, or one biomechanical entity as the SOLE cause of the complaint, whether blaming all of a client’s back pain on a disk injury or blaming their inability to do a plank on poor abdominal strength. While these answers may be a part of the story, they are almost never the full story”.   Dr. Eric Cobb


The Vision System and Spinal Health

About 60% or more of the information the brain receives regarding posture comes from the eyes, thus vision must be looked at when someone is suffering from back pain. Also on what is called the neural hierarchy in terms of information the brain receives to determine one’s place in space and to move is as follows Vision is on top, then there is the vestibular system and at the bottom is the proprioceptive system (joints, muscles, fascia etc.). Most of us have a dominant eye because the dominant eye processes information more quickly there often a slight movement bias to use the eye more under stress and this can lead to pain. This movement bias would be the reorienting of the proprioceptive system to line the body up under this eye dominance particularly under stress. I see this all the time with clients that their middle is oriented in the direction of the non-dominant eye. So, their head neck and trunk is rotated that way and this eventually can lead to spinal dysfunctions hence back pain. Eye suppression which can be called an integration problem in the brain’s vision centers which can lead to one eye functioning as both should in varying situations and as mentioned before with the eye dominance it can have a similar effect.


The Vestibular System and Spinal Health

The vestibular system plays an important role in what is termed the spinal movement symphony (Herdman & Clendaniel, 2014).

The vestibular system is also known as the inner ear and its pathways are related to stabilizing one’s vision and body and orienting us against gravity.

When one looks at the neurology of the vestibular system one will find that there are two pathways from the inner ear to the body. These pathways are called the lateral and medial vestibulospinal tracts. The lateral vestibulospinal tract projects ipsilaterally down the spinal tract (which means left inner ear projects down the left side of the body) and helps maintain balance and posture by stimulating the extensor muscles of the spine and lower extremity (Fitzgerald, Gruener & Mtui, 2012).

Look at how many times people are told your posterior chain needs works and it may not be a solely a muscular issue but a lateral vestibulospinal tract issue.

The medial vestibulospinal tract is only found in the cervical spine and above. It projects bi-laterally down the spinal cord and controls neurons that is associated with Cranial Nerve XI which innervates the trapezius and sternocleidomastoid(SCM) muscles. These muscles stabilize the neck and head in various movements. This tract also projects upwards and helps to keep the eyes yoked together in rapid head movements so one can keep their eyes on a target when the head is moving. The medial vestibulospinal tract is key to head, whole body orientation and posture, thus very important in spinal health.

Thus, it is important in any back-pain client that they get both their vision and vestibular system assessed as the modalities they were using before was only addressing the manifestations of an underlying vision or vestibular dysfunction or both.

Here’s a list of conditions that can be a result of vestibular dysfunctions:

  • Chronic Spinal Pain and movement disturbances
  • Scoliotic changes to the spine
  • Fatigue and low energy levels
  • Decreased strength and coordination
  • Poor flexibility
  • Visual disturbances
  • Anxiety issues
  • Declining sports performances

Back pain must be looked at through neural lens as often it is not simply a biomechanical dysfunction and the vision and vestibular systems must be addressed in assessment and training.



Fitzgerald, M.J., Gruener, G & Mtui, E. (2012). Clinical Neuroanatomy and Neuroscience (6th edition)

Herdman, S.J., & Clendaniel, R. (2014) Vestibular Rehabilitation (4th edition) F.A. Davis Company

Eric Cobb D.C. (2015). Why Your Client’s Back Pain Keeps Returning: Vestibular System

Eric Cobb D.C. (2016). S-Phase Manual. Z-Health.