Cervical Facet Joint Pain

Cervical Facet Joint Pain

Article by John Miller

What is Cervical Facet Joint Pain?

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

Your cervical facet joints (also known as zygapophyseal, apophyseal, or Z-joint) are synovial joints between the vertebrae of your neck. 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 the 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).

Cervical facet joint pain is one of the most common causes of neck pain.

What Causes Cervical 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, e.g. 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 have local muscle weakness supporting your facet joints, it is even easier to lock a facet joint repeatedly.

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.

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 spasms will attempt to protect the injured facet joint.

The initial injury can sometimes occur days or occasionally weeks earlier. Most commonly, you will notice decreased movement and pain or difficulty stretching. 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 of the locked facet joint and may lead to other conditions such as sciatica or arm pain.,

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 fail to control your spine’s movement.

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. X-rays, MRI’s and CT scans are used to identify arthritic changes and fractures but cannot detect a locked facet joint.

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

Cervical 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 neck 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 from 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. Your 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/Dry Needling

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 neck physiotherapist for their professional opinion on what treatment plan is best for you.

Article by John Miller

When Should You Be Concerned About Neck Pain?

What's Urgent?

There is one situation where there’s no need to wait several weeks before deciding if your neck pain is serious.

If you’ve had an accident with forces that may have been sufficient to fracture your spine or tear nerves, seek a medical assessment as soon as possible. This means to either call an ambulance or head to a hospital emergency department.

Red Flags for Neck Pain

Otherwise, the rule of thumb is that you should start a more thorough medical investigation only when all three of these conditions are met. The three general red flags for neck pain are:

  1. it’s been bothering you for more than about six weeks
  2. it’s severe and/or not improving, or getting worse
  3. there is at least one other “red flag” (see below)

Red flags are reasons to seek a professional opinion rather than to worry. Seek the advice of your physiotherapist or doctor if any of these red flags apply to you.

  • Light tapping on the spine is painful.
  • A torn artery may cause severe, throbbing or constrictive (novel pain), with a high risk of a stroke. Pain is the only symptom of some tears. Most but not all cases are sudden, on one side, and cause both neck and head pain (in the temple or back the skull), but the pain is usually strange. Any hint of other symptoms? Promptly attend a hospital emergency.
  • There are many possible signs of spinal cord trouble in the neck, with or without neck pain, mainly affecting the limbs: e.g. poor hand coordination; weakness, “heavy” feelings, and atrophy; diffuse numbness; shooting pains in the limbs (especially when bending the head forward); gait awkwardness. Sometimes patients present with both neck pain and more remote symptoms and don't realise they are related.
  • Unexplained episodes of dizziness or nausea, and vomiting may indicate a problem with the stability of the upper cervical spine. 
  • Weight loss without dieting (it's a potential sign of cancer).
  • Mystery fevers or chills (especially in people with diabetes).
  • A severe headache that comes on suddenly is a “thunderclap headache”! Most are harmless, but it is always wise to investigate thoroughly.
  • A fierce headache, an inability to bend the head forward, fever, or altered mental state. These are all symptoms of meningitis (inflammation of the membranes covering the brain and spinal cord, caused by infection or drug side effects).
  • The main signs that neck pain might be caused by autoimmune disease specifically include:
    • a family history of autoimmune disease,
    • gradual but progressive increase in symptoms before the age of 40,
    • marked morning stiffness,
    • pain in other joints as well as the low back,
    • rashes,
    • difficult digestion,
    • irritated eyes, and
    • discharge from the urethra (bladder).
  • Steroid use, other drug abuse, and HIV are all risk factors for a serious cause of neck pain.
  • If you feel pretty unwell in any other way, that could indicate that neck pain isn’t the only thing going on.

More info: Neck Pain

Article by John Miller

How Can You Relieve Your Neck Pain?

Neck Physiotherapy Treatment

The best treatment for your neck pain is determined entirely by the specific reasons for WHY you are suffering neck pain. Everyone is different, but there are some common similarities.

Your physiotherapist is highly skilled at the diagnosis and treatment of mechanical neck pain and headache. Posture correction is essential, but it depends on the availability of enough joint and muscle flexibility to attain a good posture, plus muscle strength and endurance to maintain your proper position. Address any deficit.

We understand that your neck pain may not be solely about stiff or wobbly joints or tight/weak neck muscles. A whole gamut of information that your physiotherapist will analyse during your diagnostic consultation and then commence correcting your problems. They'll also consider other systemic conditions that can cause neck pain, e.g. cancer, and direct you towards the appropriate healthcare practitioner if necessary.

Fortunately, the vast majority of neck pain does come from your neck joints and muscles. Pleasingly, researchers have shown that a combination of neck joint and muscle treatment performed by your physiotherapist and some specific strengthening exercises are an effective way to eliminate your neck pain, stiffness and headaches.

Please get in touch with your trusted healthcare practitioner for advice specific to the diagnosis and management of your neck pain.

Common Neck Pain Treatment Options

If you are in severe neck pain or have a stiff neck, it is best to assess promptly to exclude any red flag conditions such as cancer and then commence the best neck treatment straight away.

Chronic neck pain can be a lingering problem due to habit. Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your neck symptoms, the better your outcome.

What's the Best Pillow for Neck Pain?

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The correct pillow is also vital. If you are waking through the night or in the morning with a stiff or painful neck, it may be that it's your pillow and not your neck that is the cause.

Will A Posture Brace Help Your Neck Pain?

Posture support braces have improved over the years, with new designs beneficial in building awareness of the correct posture. Bracing or posture taping is excellent for teenagers, the elderly or those using computers.

There are various posture braces available. You can find more information about posture braces via our online shop.

Should You Wear A Neck Collar?

A neck collar is not recommended for most non-traumatic injuries as the collar encourages muscle weakness. However, in severe neck spasm conditions such as wry neck or whiplash, a collar is sometimes used in a few days to assist with muscle relaxation. Rarely is a neck collar required beyond four days.

Please ask your physiotherapist for specific advice.

For more advice, please consult your neck physiotherapist.

Article by Jamie Van Beek

What Causes Neck Pain Without Injury?

Neck Pain without injury is a common complaint in the clinic. It can be frustrating to wake up without any triggering event and be stuck with neck pain. 

The driver of this pain may be a muscle strain, a sprained facet joint or a bulging disc. These structures become injured due to repetitive microtrauma instead of a single event associated with injury. The microtrauma may be caused by poor posture, poor sleeping positioning or repeated movements throughout the day, which place a high load on the neck.

How Do I Fix My Posture?

The spine is made up of three curves. A concave curve in your lower back, a convex curve in your mid-back and another concave curve in the neck. Research has shown that people with neck pain have a flattening of the curve in their neck, resulting in a forward head posture. 1

An injury to any part of the spine can cause changes to spinal alignment, which can often flow onto the neck. A flattened lower back curve is a common postural adaptation from lower back pain. This increases the postural demand of the muscles which keep the head upright. Over time, these muscles may spasm and produce pain or fail and allow the head to float forward. 

This is just one possible mechanism out of many. Your physiotherapist can identify which previous injuries may be contributing to your neck pain and the influence it's having on your neck.

Forward head postures may also result from sustained positions such as looking down at a phone and looking down at laptops and gaming.  Text neck is becoming more prevalent in our community.

What Is The Consequence of a Forward Head Posture?

Each vertebral level in the neck is made up of three joints. At the front, the vertebral bodies and discs make up the joints of the spinal column. At the back, facet joints sit on either side of the spinal cord. 

A forward head posture shifts the weight of the head forward, stressing the vertebral bodies and discs in the neck. A loss of this natural curve has been linked to conditions such as cervical spondylosis, bulging discs and chronic neck pain [1]

This condition has become known as Nerd Neck.

How Should I Sleep With Neck Pain?

Sleep positioning should focus on reducing strain on the front joints of the neck (the vertebral body and disc). In side-lying, this means sleeping as upright as possible in order to avoid curling up into the foetal position and encouraging a forward head posture. To achieve this, try moving your pillow a couple of inches upwards and stretching your neck up to meet it.

When sleeping on your back, it's important to find a pillow that fully supports your neck to prevent it from rotating. The pillow also shouldn’t be too thick, to prevent encouraging a forward head posture.

Sleeping on your back is not recommended due to the sustained positions the neck has to maintain all night.

Solving Your Neck Pain

Whether your neck pain is caused by sleep positioning, poor posture or repetitive movements involving the neck, your Physiotherapist is trained to identify and treat the cause. Contact your Physiotherapist for an individualised assessment.

Reference

[1] Alpayci M, İlter S. Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2017 Sep;96(9):621-626. doi: 10.1097/PHM.0000000000000698. PMID: 28118272.