Cervical facets – what are they and is it causing my pain?
The Scenario: 33 years old. Tripped getting slide tackled in a soccer game and landed awkwardly on my side. My neck’s been sore ever since. Sometimes it’s sharp, but mostly it’s pretty dull and achy. It hurts to look over my shoulder. My physio says it sounds like a facet joint problem but… what is that?
The Anatomy: your spine is composed of block-like bones called vertebrae – with the block-like component of the vertebrae called the vertebral body. Protruding off of the vertebral body are several bony projections that are named “processes”. In its simplest form, each of these bony processes can basically be grouped into 1 of 3 categories: (1) a pair of transverse processes that stick out to the side (“trans” being Latin for “across”), a single spinous process that sticks out the back (“spina” being Latin for “thorn”), and a pair of articular processes on either side of the vertebrae that protrude upwards (ie. superior) and downwards (ie. inferior) away from the vertebral body (“articulus” being Latin for “small, connecting part”).
On either end of the articular processes, is a small rounded surface covered in cartilage called your facets (literally translated from the old French “facette” meaning “face” – or in other words, the face of the articular process). When a facet from one vertebrae meets the facet from another vertebrae, this makes a joint, and logically this joint is called your facet joint.
Every vertebrae in your spine connect to each other in 2 places: (1) by stacking one vertebral body on top of another vertebral body with gel-like discs that sit in between, and (2) by stacking the facets. The vertebral body connection only allows very little movement, however the facet joints have some wiggle room to them, and it is this wiggle room that gives each vertebrae, and essentially your spine, the ability to move. Anatomy – check!
The Injury: now sometimes facet joints can get stuck – I often tell my guys that just like how the joints in your finger can get jammed, so can the facet joints in your spine. This can happen for several reasons: sudden impact, repetitive impact, looser or unstable facet joints that wind up sitting out of alignment (I like to think of it as a dresser drawer that’s come off the guiding rails and then can no longer slide smoothly back and forth), tight muscle groups compressing the joints together, etc. etc. – it can be a singular cause, or most often, any combination of the factors listed.
Your Symptoms: besides pain, with a stuck or stiff facet joint you’ll essentially feel, well, stuck. Usually it’ll be one-sided, and movements towards that affected side will feel muggy, or stiff and painful. Sometimes you might feel like you just need it to crack. If it’s a stiff facet joint in your neck you can get headaches or dizziness, blurry vision or ringing in your ears, maybe even some nausea. If it’s in your mid-back, or thoracic spine, you might have a hard time taking in a deep breath. In your lower back, the symptoms may radiate into your hips or down your leg.
Now sticking with the neck scenario, the location of your symptoms itself can give us a good idea which facet joint is affected. A good clinician with a strong understanding of anatomy can usually deduce what structure is injured, but whenever supporting research is available to back up that suspicion, even better. In 1990, Anthony Dwyer and his colleagues looked to investigate how each cervical (ie. neck) facet joint manifested its symptoms.1 These type of studies are termed pain referral studies.
I love pain referral studies. They’re fairly straightforward in their design – find a bunch of people without any history of injuries to that region, inject a painful stimulus, have them describe where they feel their symptoms, and then investigate if there’s an overlap between everyone involved. Here’s what they found – a fairly unique referral pattern depending on what facet joint was painful.
Awkward landing from a fall on the right side, sudden pain in the neck with persistent stiffness over several days, pain looking up or over the right shoulder, and pain location around the top part of the shoulder blade? Sounds like a potential C5 – C7 facet joint problem.
The Solution: this is a physiotherapy blog post after all… but there are lots of options. First, get the facet joint moving again – this can be in the form of a mobilization (ie. gently “guiding” the movement back into the joint) or a manipulation – aka an adjustment, which only advanced orthopaedically trained physiotherapists or chiropractors can perform.
Second, get the muscle a bit more pliable – often when a facet joint is stiff, muscle groups need to work quite a bit harder to perform the movement which can make them over-worked and tense. Think of a stiff facet like a stiff pulley – and how much more work it would take to hoist anything with it. Muscle work can be in the form of soft-tissue techniques (massage, active-release, graston, trigger-point therapy, etc. etc.) or it might need to get more aggressive (ie. IMS) depending on the injury.
Thirdly, exercise – which could be a whole post on itself. An exercise to keep the specifically affected facet joint moving? Exercises to help keep the muscle groups pliable and flexible? Neck strengthening exercises to build-up any underlying strength deficits that may have predisposed the injury from occurring? Neck coordination exercises to help smooth out a motor control problem that may have predisposed the injury from occurring? Postural awareness/control exercises to help reduce the strain placed on your neck from prolonged sitting happening during your commute or work? Shoulder mobility exercises to improve your shoulder flexibility and reduce how much your neck is compensating to help? All of the above?
As I’ve mentioned in previous posts, exercise is the absolute foundation for maintaining a change. As I tell my guys, going to the dentist is somewhat pointless if you don’t brush on your own time.
Facet joint problem? Or suspected facet joint problem? Get it checked out – there’s lots that we can do.
Dwyer A, Aprill C, Bogduk N. “Cervical zygopophaseal joint pain patterns I: a study in normal volunteers.” Spine 1990;15(6):453:457.