Cervical Facet Joint Pain

Facet Joint Pain

What is Facet Joint Pain?

Facet joint pain is also commonly referred to as facet joint syndrome, facet joint disease, facet joint sprain but essentially it is the pain caused by a facet joint injury.

Your facet joints (also known as zygapophyseal, apophyseal, or Z-joint) are synovial joints between the vertebrae of your spine. There are two facet joints (left and right) in each spinal motion segment.

Biomechanically, the function of each pair of facet joints is to guide and limit movement of that spinal motion segment.

Each section of your spine has facet joints. You may hear them referred to as your cervical facet joints (neck), thoracic facet joints (mid-back) and lumbar facet joints (low back).

Facet joint pain is one of the most common causes of neck pain, back pain and thoracic spine pain.

What Causes Facet Joint Pain?

Facet joint motion can be disturbed by injury. Joint motion can stiffen – known as hypomobility. Alternatively, joint motion can become excessive – known as hypermobility.

What Causes Facet Joint Hypomobility?

Facet joint hypomobility can be caused by:

  • locked facet joint,
  • facet joint arthritis,
  • degenerative facet joint osteophytes (bone spurs),
  • joint capsule scarring, thickening or shortening, or
  • protective muscle spasm.

In other words, a facet joint can stiffen due to a slow degeneration or due to uncontrolled motion, which is where your local muscle strength is important to stabilise and control your facet joints.

What Causes Facet Joint Hypermobility?

Hypermobility is usually caused by trauma:

  • fracture,
  • dislocation,
  • overstretched ligaments, or
  • a disease that destroys the joints eg Rheumatoid arthritis.

What Causes a Locked Facet Joint?

Simple movements such as a mild twist, awkward movement or just doing something your body didn’t expect (such as tripping) can lock a facet joint. In most cases, this is due to your facet joints motion exceeding your muscle control.

If you have previously suffered injury or you have local muscle weakness supporting your facet joints than it is even easier to repeated lock a facet joint.

What are the Symptoms of a Locked Facet Joint?

Pain is one of the first symptoms a patient will notice with a facet joint injury. A neck facet joint will cause neck pain and potentially shoulder or upper arm pain. A back facet joint injury will cause low back pain and potentially pain referred to your buttock or thigh.

When a facet joint locks, you may not be able to move in the direction away from where it’s locked. For example, if the joint is locked in a flexed forward position, you will probably have difficulty arching backwards. The opposite also occurs. In acute phases, muscle spasm will attempt to protect the injured facet joint.

The initial injury can sometimes occur days or occasionally weeks earlier. Your body will attempt to compensate for the locked joint by the neighbouring joints moving more than they normally would. This can often cause pain on the opposite side to the locked facet joint and may potentially lead to other conditions such as sciatica or arm pain. Most commonly you will notice decreased movement and pain or difficulty stretching.

People who have this problem recurrently are said to have facet joint syndrome. The most common cause of facet joint syndrome is weak stability muscles that are failing to control the movement of your spine.

How is a Facet Joint Injury Diagnosed?

The most accurate diagnosis of a facet joint injury is via a hands-on examination from a physiotherapist who specialises in spinal physiotherapy. Using their professional skills they will confirm the specific facet joint problem and whether it is locked, stiff or unstable. Xrays, MRI’s and CT scan are used to identify arthritic changes and fractures but are unable to detect a locked facet joint.

Please consult your physiotherapist for specific advice regarding your facet joint pain management.

Facet Joint Syndrome Treatment

The treatment for a locked facet joint is relatively simple. Your physiotherapist will quickly detect which facet joint is locked. Then proceed to unlock it. Usually, a locked facet can be unlocked using a painless joint releasing technique.

The next step is to regain full motion and commence strengthening or other exercises to prevent a future, recurrence. Everyone is slightly different, so your treatment will vary depending on what deficits your physiotherapist has found during your examination.

Unstable Facet Joint Treatment

Unstable or hypermobile facet joints need to be treated entirely differently to a locked facet joint. The fact that the joint already moves excessively would suggest that further joint loosening is unlikely to assist a hypermobile facet joint.

These patients respond better to muscle control and stabilisation program. You physiotherapist will guide you.

Please check with your physiotherapist or doctor for their professional opinion.

What Results Can You Expect?

Physiotherapy will provide the majority of facet joint pain patients with complete relief. (Hu et al 2006). Locked facet joints will normally start improving immediately post-unlocking. How they progress beyond that depend on what other concomitant factors are present. How long has the joint been locked? What caused the locking? What adjacent joint motion there is available?

Based on your physiotherapist’s examination, they will be able to provide you with more accurate guidelines. Facet joint instability will take longer to rehabilitate since they require time and practice for your muscle strengthening to occur. Once again, please check with your treating physiotherapist for their professional opinion and treatment plan.

Other Treatment Options

Massage

Massage can be an excellent form of muscle spasm relief to allow your facet joint spasm to release.

Acupuncture

Localised acupuncture or dry needling techniques can provide localised muscle spasm and facet pain relief. Ask your physiotherapist for more advice.

Facet Joint Injections

Facet joint injections are sometimes used to confirm a diagnosis and provide short-term (a week or two) relief. Researchers have found that facet joint injections are less effective than patients who exercise in the long-term. (Mayer et al 2004)

Radiofrequency

Radiofrequency is sometimes used in chronic cases which do not respond to physiotherapy treatment. Radiofrequency cauterizes the nerve, providing pain relief for a period of time. The downside is that the pain normally returns when the nerve regrows within a few months.

Summary

Every case of facet joint pain is different. Please check with your physiotherapist for their professional opinion. on what treatment plan is best for you.

FAQ’s about Facet Joint Pain

Nerve Pain

Nerve pain is pain that is caused by damage or disease that affects the nervous system of the body. It is also known as neuropathic pain or neuralgia. Nerve pain is a pain that comes from problems with signals from the nerves. It is different to the common type of pain that is due to an injury. This is known as nociceptive pain.

What Causes Nerve Pain?

nerve painNeuropathic pain is caused by a problem with your nerves themselves, which sends pain messages to the brain.

What is Nerve Pain Symptoms?

Nerve pain is often described as burning, stabbing, shooting, aching, or like an electric shock.

What Causes Nerve Pain?

Various conditions can affect your nerves and cause nerve pain. Common sources of nerve pain include:
  • Shingles (post-herpetic neuralgia).
  • Trigeminal neuralgia.
  • Diabetic neuropathy.
  • Phantom limb pain following an amputation.
  • Cancer.
  • Multiple sclerosis.
  • Chemotherapy.
  • HIV infection.
  • Alcoholism.
  • Other nerve disorders.

Nerve Pain & Nociceptive Pain

You can suffer both nerve pain and nociceptive pain simultaneously. Both pain types can be caused by the same condition.

Nerve Pain Treatment

Nerve pain is less likely than nociceptive pain to be helped by traditional painkillers such as paracetamol, anti-inflammatories and codeine.  However, other types of medicines often work well to ease the pain. Nerve pain is often eased by anti-depressant or anti-epileptic medicines. Please ask your doctor for more advice.

Pain Links

Pain & Injury

Tens Machine

What is a TENS Machine?

Pins and Needles - Paraesthesia

What Causes Pins & Needles?

A moderately pinched nerve is the most common cause of "pins and needles". Pins and needles are referred to as "paraesthesia" in the medical community. Did you know that feeling "pins and needles" can be a worse sign than having pain in your arm or leg? The reason is that you can't even feel pain anymore when you significantly squash the nerve.

Even worse than "pins and needles" is "numbness" or "anaesthesia", which is a total lack of sensation. You will experience anaesthesia when there is severe nerve compression. Anaesthesia or numbness that persists for more than a few hours can be a sign of permanent nerve compression. Please seek prompt medical attention to prevent the nerve from permanent damage and the muscles it innervates to weaken drastically.

The majority of pinched nerves and nerve compressions are only transient and quickly reversed with early treatment. However, neglect can lead to permanent nerve compression injuries, which may never recover.

Common Causes of Pinched Nerves

The most common forms of nerve compression are in the spinal joints where either a disc bulge or a bony arthritic spur can irritate and compress the nerve. Compressions can also occur as the nerve passes through or around muscles. Your physiotherapist will know where to look.

How Can You Fix "Pins and Needles"?

If you know of someone who is experiencing chronic or permanent "pins and needles", "numbness" or "muscle weakness", please encourage them to seek urgent professional advice. The secret to quick success is the correct diagnosis. A highly trained health practitioner such as your physiotherapist or doctor is your best port of call.

More info

Youth Spinal Pain

Teenager Neck & Back Pain

teenager back painTeenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control. The competitive athlete and most individuals who exercise regularly or maintain a level of fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Your physiotherapist can assist the resolution of any deficits in this area. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports.Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions.Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these type of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.

Common Adolescent Spinal Injuries

Lower Back (Lumbar Spine)

Midback (Thoracic Spine)

Neck (Cervical Spine)

Pelvis

For specific advice regarding youth neck or back pain, please seek the professional advice of your trusted spinal physiotherapist or doctor.Common Youth & Teenager Sports InjuriesCommon Youth Leg InjuriesCommon Youth Arm Injuries

Back Muscle Strains

Back muscle injuries are the most common form of back injury. Muscle fatigue, excessive loads or poor lifting postures are the most common problems. Inefficient back muscles can lead to poor joint stabilisation and subsequent injury.More info: Back Muscle Pain

Ligament Sprains

Ligaments are the strong fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling and pain. Awkward lifting, sports injuries, and motor vehicle accidents are very common causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.More info: Back Ligament Sprains

Bulging Discs

A bulging disc injury is a common spine injury sustained to your spine's intervertebral disc. Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs.The annulus is the outer section of the spinal disc, consisting of several layers of multi-directional fibrocartilaginous fibres all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus. A disc bulge (commonly referred to as a slipped disc), can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain in your legs.More info: Bulging Discs

Bone Injuries

You can also fracture your spine if the force involved is highly traumatic or you have a low bone density (e.g. osteoporosis).More info: Osteoporosis

Poor Posture

Poor posture when sitting, standing or lifting at work can place unnecessary stress on your spine. Muscles fatigue, ligaments overstretch, discs stretch and this places spinal joints and nerves under pain-causing pressure.More info: Poor Posture

What Can Cause Severe Low Back Pain?

A sudden injury most often causes acute low back pain. The most common injury sources are the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments. But occasionally, it can have a more sinister cause.

Warning Signs of a More Serious Back Injury?

In these instances of neurological deficit, please urgently consult your nearest hospital, doctor or physiotherapist. The following neurological signs warrant prompt assessment:
  • pins and needles (paraesthesia),
  • numbness (anaesthesia),
  • leg muscle weakness,
  • altered reflexes,
  • difficulty walking,
  • loss of control of bladder or bowels.

Non-Musculoskeletal Causes of Low Back Pain

Although most low back pain is musculoskeletal in origin, other health conditions can cause low back pain.
  • Abdominal aortic aneurysm
  • Infection of the spine (osteomyelitis, discitis)
  • Kidney infection or kidney stones
  • Spondyloarthropathies: e.g. rheumatoid arthritis, psoriatic arthritis.
  • Female reproductive organs: e.g. pregnancy complications, ovarian cysts or cancer, endometriosis
Please seek the professional advice of your trusted and experienced healthcare practitioner to diagnose the cause of your lower back pain.

What Causes Lower Back Pain?

Researchers and spinal health care practitioners categorise lower back bain into the following categories:1. Specific Spinal Pathologies  (<1%)2. Radicular Syndromes (5-10%) 3. Non-Specific Lower Back Pain (NSLBP) (Bardin et al., 2017)

Specific Spinal Pathologies

Some conditions that cause back pain do require an urgent and specific referral and treatment. These conditions include: These conditions do require early diagnosis and prompt referral to the appropriate medical specialist.  Luckily these conditions account for less than 1% of back pain sufferers, but you don't want them missed.Some referrals should be IMMEDIATE!

Radicular Syndromes

Lower back pain can result from structural damage that can irritate or pinch a nerve. Researchers believe that radicular syndrome causes 5-10% of the presentations of back pain to general practitioners.

Radicular pain (e.g. sciatica)

The most common pinched nerve in the lower back is your sciatic nerve. You may be diagnosed with sciatica if you are suffering radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve that can be affected by a spinal injury, you can modify any spinal nerve function (e.g. femoral nerve).The following back injuries may cause radicular pain: Pain is due to swelling or space-occupying material adjacent to the spinal nerve. The affected nerve may be simply irritated, resulting in radicular pain. Or, even worse, become pinched or compressed, resulting in radiculopathy.

Radiculopathy

Lumbar radiculopathy can result in functionally disabling conditions such as foot drop, foot slap or eversion muscle weakness that can affect your ability to walk.

Spinal Stenosis

Spinal stenosis is a slightly different condition and relates to the narrowing of the spinal canal. Spinal stenosis is usually more prevalent as you age.

Non-Specific Lower Back Pain (NSLBP)

Non-Specific Lower Back Pain (NSLBP) is the diagnostic term used to classify sufferers of lower back pain with no specific structure injured. It is a diagnosis of exclusion. In other words, your spinal health care practitioner has excluded specific spinal pathologies and any of the radicular syndromes mentioned above as the cause of your back pain or symptoms.Fortunately, these conditions account for approximately 90-95% of lower back pain and can nearly always successfully rehabilitate without the need for surgery. Most improve within two to six weeks. They can be fast-tracked with pain relief and physiotherapy techniques such as manual therapy and back exercises.

NSLBP Causes

 The causes of NSLBP are numerous but roughly fall into either a sudden (traumatic) or sustained overstress injuries.Most people can relate to traumatic injury such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries (e.g. poor posture) are probably more common but also more straightforward to prevent. In these cases, positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period to cause injury and back pain.Most commonly, NSLBP causes include back muscle strain or back ligament sprain. Other chronic back conditions such as degenerative disc disease may underly your acute disc health and predispose you to the severe pain.The good news is that you can take measures to prevent or lessen most back pain episodes. Early diagnosis and specific individualised treatment is the easiest way to recover quickly from lower back pain and to prevent a recurrence.

What is Back Muscle Pain?

Back muscle pain or its aliases: pulled back muscle, back muscle spasm, torn back muscle or back muscle strain, is very common. Back muscle pain is the most common source of back pain. The good news is that it is also one of the quickest to heal and rehabilitate.

What Causes Back Muscle Pain?

Most causes of low back pain are muscle, ligament or joint-related. Commonly, these muscular strains, ligament sprains and joint dysfunction arises suddenly during or following physical loading of your spine. Muscle fatigue, excessive loads, high speeds or poor lifting postures are the most common causes.The causes of pure back pain are numerous but roughly fall into the following categories.

Back Muscle Strains

Muscle pain is the most common source of back pain. Muscle fatigue, excessive loads or poor lifting or sitting postures are the most common problems.Inefficient, weak, or back muscles that lack endurance or normal contraction timing can lead to reduced joint stabilisation and subsequent injury to your back muscles, ligaments, joints or even spinal discs.

Poor Posture

Poor posture, when sitting, standing and lifting at work, can place unnecessary stress upon your spine. With muscle fatigue or overstretching, your ligaments and discs can stretch, and this puts spinal joint muscles and nerves under pain-causing pressure or strain, that results in back pain.

Ligament Sprains

Ligaments are the durable, fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling, muscular spasm and pain.Awkward lifting, sports injuries and motor vehicle accidents are prevalent causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.

What are the Symptoms of Back Muscle Pain?

Back muscle pain symptoms may range from a mild ache to sudden debilitating back pain.Typical back muscle pain symptoms include:
  • Localised back pain, with no radiation into your buttock or leg.
  • Back muscle tenderness and spasm.
  • Protective back stiffness.
  • Sudden back pain onset.
You will usually feel better when resting and may find a change of position painful, e.g. sit to stand, rolling in bed, walking or bending.

How is Back Muscle Pain Diagnosed?

Differentiating a back muscle strain from a ligament sprain can be difficult, as both injuries will show similar symptoms. In general, it doesn't significantly matter what you call the problem because the treatment and prognosis for both back muscular strains and ligament sprains are similar. Most spinal practitioners refer to both injuries as a category called a "Back Strain" or "Musculoligamentous Strain".X-rays and CT scans do not identify muscle or ligament injury. MRI scan is probably the best diagnostic test to determine the muscle or ligament structures injured.

What is Back Muscle Pain Treatment?

Seek a Professional Diagnosis!

A spinal healthcare practitioner, such as your physiotherapist, should thoroughly; examine you to exclude more severe sources of back pain.Numerous injuries can cause back pain, and the treatment does vary significantly depending on your diagnosis. Physiotherapy treatment aims to protect your damaged tissue while hastening your muscle and ligament healing and then look at strategies to prevent a recurrence.Your physiotherapist has some nifty tricks for quickly relieving your back pain so that you can enjoy life again as soon as possible.

Back Strain Causes

We do know that some people are vulnerable to repeated lower back sprains and strains. While it is easier to understand that lifting a heavy load in an awkward position can cause back pain, it's harder to comprehend how a simple movement can hurt your back. Yes, it can happen by merely leaning forwards to pick up your teacup or when bending to brush your teeth!The reason is poor local joint control. The main reason for this is inadequate or non-existent muscle activation of the deep core stability muscles. These muscles are small but are right next to the joint to control excessive slides and glides. When they don't work correctly, the joint can slide too far and strain its supporting ligaments. Ouch! That hurts.The good news is poor core stability can be easily corrected to prevent back pain. Please contact your physio for more information or to have your core activation accurately assessed.High-risk factors of back pain include:
  • sudden forceful movement
  • lifting a heavy object
  • twisting the back
  • coughing or sneezing
  • prolonged sitting with poor posture
More information about Back PainMore information about Deep Core Stability