Facet Joint Sprain (Cervical)

Injuries > Neck & Head > Facet Joint Sprain

(Also known as Neck Sprain, Apophyseal Joint Sprain, Apophyseal Wry Neck, Zygaphophyseal Joint Sprain, Sprained Facet Joint)

What is a facet joint sprain?

The spine (neck) comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally (figure 1). These joints are designed to support body weight and enable spinal movement.

Each facet joint comprises of strong connective tissue wrapping around the bony ends and cartilage which lies between the bony joint surfaces, cushioning the impact of one bone on another.

During certain movements of the neck, stretching or compression forces are placed on the facet joint. If these forces are excessive due to too much repetition or high force, injury to the facet joint may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. When this occurs, the condition is known as a facet joint sprain.

Causes of a facet joint sprain

Facet joint sprains typically occur during excessive lifting, bending, slouching, or twisting movements of the neck. This may occur traumatically due to a specific incident or due to repetitive or prolonged forces. They may also occur during sleeping particularly in poor posture (figure 2).

Signs and symptoms of a facet joint sprain

Patients with a facet joint sprain may experience a sudden onset of neck pain during the causative activity. However, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning.

Symptoms are typically felt on one side of the neck and muscle spasm may be experienced around the affected joint. Occasionally pain may be referred into the shoulder, upper back or arm on the affected side. Symptoms are generally exacerbated with activities that involve turning the head, bending forwards or sideways, lifting objects, arching the head backwards or slouching for prolonged periods of time (e.g. when sitting – figure 2).

Diagnosis of a facet joint sprain

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a facet joint sprain. Investigations such as an X-ray, MRI or CT scan may be required to confirm diagnosis.

Treatment for a facet joint sprain

Most patients with a facet joint sprain heal quickly and have a full recovery with appropriate physiotherapy. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. Activities placing large amounts of stress on the facet joint should also be minimized, particularly twisting the neck (excessively), slouching, bending the neck forwards and heavy lifting. Generally, sitting for prolonged periods should be avoided. However, if inevitable, optimal sitting posture is vital to minimize stress on the facet joint. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your bottom in the back of the chair and a lumbar support in the small of your back. Your shoulders should be back and your chin should be tucked in slightly (as long as this is pain-free) (figure 3).

Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated whilst maintaining optimal posture, provided there is no increase in symptoms.

It is also important for patients with this condition to perform early movement and strength exercises to prevent stiffness and weakness from developing and to ensure the neck is functioning correctly. The treating physiotherapist can advise which exercises are appropriate and when they should be commenced.

Prognosis of a facet joint sprain

The recovery time following a facet joint sprain may vary from patient to patient depending on compliance with physiotherapy. With ideal treatment, patients may be pain free in as little as several days, although typically this may take 2 – 3 weeks. It is important to note, however, that injured tissue takes approximately six weeks to restore the majority of its strength in ideal healing conditions. Care must therefore be taken when returning to activity during this period.

Physiotherapy for a facet joint sprain

Physiotherapy for a facet joint sprain can hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:

• soft tissue massage
• joint mobilization
• electrotherapy (e.g. ultrasound)
• postural taping
• postural bracing
• dry needling
• the use of a lumbar roll for sitting
• the use of an appropriate pillow for sleeping
• education
• activity modification advice
• ergonomic advice
• clinical Pilates
• exercises to improve flexibility, strength, posture and core stability
• a gradual return to activity program

Contributing factors to the development of a facet joint sprain

There are several factors that may contribute to the development of a facet joint sprain. These need to be assessed and corrected with direction from a physiotherapist and may include:

• poor posture
• neck joint stiffness
• a sedentary lifestyle
• poor core stability
• muscle weakness or tightness
• inappropriate lifting technique
• a lifestyle involving large amounts of sitting, bending, slouching or lifting.

Other intervention for a facet joint sprain

Despite appropriate physiotherapy management, a small percentage of patients with a facet joint sprain fail to improve and may require other intervention. This may include investigations such as an X-ray, CT scan or MRI, pharmaceutical intervention, corticosteroid injection or referral to appropriate medical authorities who can advise on any procedures that may be appropriate to improve the condition.

Exercises for a facet joint sprain

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 5 times daily and only provided they do not cause or increase symptoms.

Neck Rotations

Begin sitting with your back and neck straight and your shoulders back slightly. Turn your head looking over one shoulder until you feel a mild to moderate stretch, or as far as you can go without pain (figure 4). Keep your neck straight and don't allow your head to poke forwards during the movement. Repeat 10 times to each side provided the exercise is pain free.

Figure 4 – Neck Rotations (right side)

Chin Tucks

Begin sitting or standing tall with your back and neck straight, shoulders should be back slightly (figure 5). Tuck your chin in until you feel a mild to moderate stretch pain-free. Keep your eyes and nose facing forwards. Hold for 2 seconds and repeat 10 times provided the exercise is pain free.

Figure 5 – Chin Tucks

Shoulder Blade Squeezes

Begin sitting or standing tall with your back straight (figure 6). Squeeze your shoulder blades together as hard and far as possible pain-free. Hold for 5 seconds and repeat 10 times provided the exercise is pain free.

Figure 6 – Shoulder Blade Squeezes

Other Exercises

For more neck flexibility exercises click here.

For basic Pilates exercises to improve your core stability and posture click here.

Find a Physio for a facet joint sprain

Find a physiotherapist in your local area who can treat a facet joint sprain.

Physiotherapy products for a facet joint sprain

The most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:

1. Postural supports
2. Therapeutic pillows
3. Ice packs and Heat packs
4. Lumbar rolls for sitting
5. Sports tape (for postural taping)

Click here to purchase physiotherapy products for a facet joint sprain.

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