Injury blog: Facet lock

Neck pain

Hello readers! We hope you’ve had an enjoyable Christmas and sent 2020 off with the bang it deserved. We’re kicking things off with a blog about neck pain relating to small joints in our neck known as facet joints. Are you waking up to 2021 with a pain in your neck? You might have had one too many sleeps in the armchair over the festive period. And maybe the exercise dropped off a bit as focus changed to family get-togethers and binging in front of the TV after an exhausting year. Never fear, we’ve got your back (oops… we mean neck!)

What are facet joints?

Facet joints are small joints in the neck, formed between bony parts of two adjacent vertebrae. With a few exceptions, you can find a pair of facet joints at each level of the spine: one on the left, one on the right. These joints, along with the disc connection between vertebrae, are responsible for allowing and restricting movements of the spine, depending on what region of the spine you are looking at. For example, the facet joints in the neck are orientated to allow a relatively wide range of motion in all planes of movement… Flexion and extension, rotation, and side-bending (lateral flexion). When we look over our shoulder to check our blind spot in the car, we are mainly using movement in our neck to get there.

If you move to the low back region of the spinal column, the facet joints are orientated in a slightly different way, allowing plenty of flexion and extension, but minimal rotation. This allows us to bend our bodies forwards and backwards easily.

What is a facet lock?

This condition is pretty self-explanatory from its name. A facet lock is a facet joint that is ‘locked’ or severely restricted in movement. This type of joint is what we call a synovial joint. This means it’s a joint that is held together by a joint capsule and is filled with a lubricating fluid, known as synovial fluid. A facet joint tends to lock when it has been overloaded with excessive forces acting upon it. This tends to occur over time and results in a ‘straw that breaks the camel’s back’ moment. It can also happen following a quick jerking movement of the neck, where a sudden large force is placed upon the joints and it is too much for them to bear. The tissue around the joints, including the overlying muscles which drive the movement stiffen and may go into spasm, and you are left with a neck that is extremely painful to move.

More often than not, we are moving poorly above and/or below the joint, leaving it struggling to hold everything together and keep movement going. The body is good at compensating for poor movement up to a point, and then failure is inevitable, unless we intervene.

Signs and symptoms

The signs and symptoms of a facet lock in the neck include:

  • Neck pain
  • Restricted neck movement
  • Restricted mid-back and shoulder movement
  • Headache (this is more likely if neck movement is not restored following injury)
  • Inability to perform daily tasks such as checking your blind spot whilst driving (we strongly suggest if you cannot turn your neck, to NOT get behind the wheel of a vehicle) and looking/reaching up to a kitchen cupboard

After the initial onset of pain, you will progressively lose movement in your neck over the next few hours. The following few days will be painful while your body deals with the acute inflammation occurring in and around the joint. Slowly but surely, you will begin to notice movement becoming easier and pain reducing.

We recommend coming to see us sooner rather than later. When inflammation is fresh and everything is really restricted, it is sometimes difficult to reach a 100% accurate diagnosis on the first session. But after careful questioning and consideration of your medical history, the majority of the time we can come to a solid working diagnosis. If we cannot, and we feel something else is going on, we may refer you on for a second opinion, or for imaging. Nine times out of ten, with a simple facet lock there aren’t any serious signs and symptoms which will make us question our course of action… it usually just bloomin’ hurts and is difficult to move your head. In those cases, we can get to work immediately.

Treatment

A locked, compressed and inflamed facet joint usually responds pretty well to some gentle traction of the neck. Traction techniques gently separate the joint surfaces, allowing for movement of fluid and for everything to calm down nicely. If you are super locked up and restricted, traction and very gentle neck mobilisations may be all we’re able to do in the early stages. We’ll cast an eye over the areas above and below the injury site to see what’s going on there, and treat those accordingly. Restoring movement in a non-painful area away from the injury site is commonly what’s needed to help calm everything down quick-smart. All being well, when you get up off the table after your first treatment, your pain will have reduced and your movement will have improved. Over the next few sessions, we will capitalise on this and aim to restore full function to your neck within 8-10 sessions, across a period of 8-12 weeks. These time periods are rough estimates and always depend on whether you do your homework with exercise, living well and avoiding potentially aggravating activities for a short time.

Injuries like these are usually the result of many years of poor movement. We encourage you to look long-term with your treatment goals. Injuries that take years to build up will not be undone in a few weeks. Yes, we will get your pain down and your movement up, but to get truly strong and mobile takes months to fully achieve. Our aim will be to get you to that point where the injury is not likely to return once treatment stops and you return to normal daily living.

Neck pain? Call us today 9078 2455 book an appointment.

References
1. Chila, A. et al. 2011. Foundations of osteopathic medicine. 3rd ed. Philadelphia: Lippincott Williams & Wilkins.
2. Snell, R. 2012. Clinical anatomy by regions. 9th ed. Philadelphia: Lippincott Williams & Wilkins.

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