Your facet joints are small, cartilage-lined points of contact where each individual vertebra (neck bone) meets the one above and below it. They both enable spinal movements, such as nodding your head but can also limit its range of motion, such as over-extending or twisting. If the cartilage of these joints is irritated or damaged, pain may occur.
Cervical FJP will typically arise from either a traumatic incident, such as whiplash, or degenerative processes, such as prolonged postures or osteoarthritis. Cervical FJP is most often felt on one side of the neck; however, it is not uncommon to experience pain on both sides of the neck or have radiating pain to the shoulders or mid-back. When the facet joints are inflamed, they are quite tender to touch, and they may cause joint stiffness, with the most common symptom presenting as a blockage or sharp pain when trying to turn your head or extending the head backward.
Cervical FJP responds very well to regular stretching and strengthening exercises for the neck and upper back. This helps to reduce stress to the facet joints by improving the overall strength and mobility of the neck, allowing it to tolerate more stressful activities.
Essential Anatomy
To better understand Cervical FJP, it is important to understand some basic human anatomy.
The cervical spine is made up of a column of seven moveable bones called vertebrae that connect to one another. Each vertebra, aside from the top two cervical joints, functions as a three-joint complex with a large disc in the front and two facet joints in the back. This tripod design is very strong! It keeps the spinal column linked together while allowing our spine to bend and twist.
The facet joints are lined with cartilage, lubricated in synovial fluid, and covered by a joint capsule. Healthy facet joints glide and slide as the neck moves, and will lock together to prevent us from over-rotating or over-extending. When there is a breakdown or damage to the facet joint cartilage, the joint becomes inflamed. This then triggers pain signals in nearby nerve endings and can result in Cervical FJP.
We also have many muscles that support our upper back, neck, and shoulders. The primary postural muscles of the neck are the deep neck flexors; these muscles are often weak in those with cervicogenic headaches. Our larger muscle groups that help assist with our neck and chest movements are our “prime movers”. These are the Trapezius (upper fibers) and Levator Scapula in the neck, and the Trapezius (middle and lower fibres) in the upper back. In Cervical FJP we often see overactivation and increased tightness of these larger muscle groups.
What causes Cervical Facet Joint Pain?
As we age, our joints and cartilage are subject to wear and tear. This causes the joint spaces too narrow, and thus the space between articulating bones decreases. This alone does not necessarily cause neck pain. It is the addition of extra load through our body that causes a weight shift onto the affected facet joints. This weight shift could be due to an injury/trauma, repetitive movements, poor postures, and/or other spinal conditions that change the way the facet joints align and move.
Physiotherapy treatment
In all cases of Cervical FJP, causative factors need to be identified and addressed. These include:
- Environmental factors (e.g. Physically intense jobs)
- Behavioural factors (e.g. Prolonged sitting without breaks, repetitive movements, poor postures)
- Lack of general exercise and movement
To address these issues, have your desk set up correctly (check out our previous blog on this topic here), get up and move regularly throughout the day, take breaks from repetitive activities, and most importantly, exercise! This will help relieve stress and reset your body.
In addition, problems with flexibility, control, and strength of the neck and shoulders are major causes of Cervical FJP.
Mobility -
Common flexibility issues include:
- A forward head posture (e.g. Poking chin forward)
- Stiff and rounded thoracic spine
- Stiff and restricted cervical movement
- Tight upper trapezius and suboccipital muscles of the neck and shoulders
- Tight sternocleidomastoid muscles that pull on the front of the neck
To address these, we use manual therapy and soft tissue massage, as well as teaching our clients to stretch and perform self-treatment with tools, such as Bakballs.
Control -
Control refers to the ability of an individual to monitor and adjust their body position and posture through a variety of different settings. When it comes to Cervical FJP, control of the cervical and thoracic spines is very important. Your physiotherapist will assess your control to determine if this a contributing factor to the problem.
In many cases, control exercises have a beneficial therapeutic effect as they introduce the body to a safe and pain-free range of motion that the person may not have been aware of.
Strength -
Strength is very important when it comes to the rehabilitation of the neck and treating Cervical FJP. Strong and resilient tissues promote optimal function and are less likely to become tight or weak. Therefore, it less likely these structures will send the brain pain signals when under pressure from poor postures or repetitive loads.
Summary:
In summary, if you are suffering from Cervical Spine Facet Joint pain remember:
1. Cervical FJP is very common and easy to fix with physiotherapy treatment
2. Changes to your work station set up, sitting behaviors and postures, and taking regular breaks from repetitive activities are very effective at reducing lower back pain
3. Flexibility, control, and strength deficits need to be identified and addressed
4. General exercise is an easy way to treat and prevent Cervical FJP!
If you are experiencing neck pain, book in with your physiotherapist for a thorough assessment using this link – FREE INITIAL ASSESSMENT. Once the cause has been identified the road to recovery can begin.
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References:
Chen, X., Coombes, B., Sjøgaard, G., Jun, D., O’Leary, S., & Johnston, V. (2017). Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis. Physical Therapy, 98(1), 40-62. doi: 10.1093/ptj/pzx101
de Campos, T., Maher, C., Steffens, D., Fuller, J., & Hancock, M. (2018). Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis. Journal Of Physiotherapy, 64(3), 159-165. doi: 10.1016/j.jphys.2018.05.003
Dory, M. (1983). Arthrography of the cervical facet joints. Radiology, 148(2), 379-382. doi: 10.1148/radiology.148.2.6867328
Kirpalani, D., & Mitra, R. (2008). Cervical Facet Joint Dysfunction: A Review. Archives Of Physical Medicine And Rehabilitation, 89(4), 770-774. doi: 10.1016/j.apmr.2007.11.028
Manchikanti, L., Boswell, M., Singh, V., Pampati, V., Damron, K., & Beyer, C. (2004). Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskeletal Disorders, 5(1). doi: 10.1186/1471-2474-5-15
Van Eerd, M., Patijn, J., Lataster, A., Rosenquist, R., Van Kleef, M., Mekhail, N., & Van Zundert, J. (2010). Cervical Facet Pain. Pain Practice, 10(2), 113-123. doi: 10.1111/j.1533-2500.2009.00346.x