By Megan Cornish, Myotherapist
Over the last week in particular there has been an increase in acute neck pain and cases of facet joint irritation. In this blog we will discuss the symptoms of an irritated facet joint and discuss available treatment options as well as some tips and tricks you can utilise at home. So, without further ado, let's dive into the wonderful world of facet joints!
Have you ever woken up one morning with neck pain and stiffness that progresses quickly into very limited ability to move your neck and intense pain? Maybe you’ve found it difficult to headcheck to the left or to the right when driving in the car so you’ve had to use your whole body to turn to do so. Maybe you have been standing under the warm water of the shower for a while now or glued to your hot pack trying to get any form of relief from extremely stiff neck muscles. If you have or are currently experiencing any of the above scenarios you may have an irritated facet joint in your neck.
Facet joints are joints that connect the bones of your spine together allowing your spine to bend, twist and rotate. Whilst providing movement they also support the spine and prevent excess movement by providing structural support to the overall spinal column. These joints sit at the back of the spine and there are 4 facet joints for each vertebrae, 2 upper and 2 lower. Sometimes these joints can become inflamed due to certain conditions such as osteoarthritis, trauma from a car accident or sport injuries, or from more mundane daily activities like sleeping awkwardly or a rapid movement that twinges the neck. For the purpose of this blog we will be addressing neck related facet joint pain however it is important to note that facet joints can get inflamed along any point of the spinal column.
How do we know that your current neck pain is facet joint related?
There will be a few different things that we look for to identify that the root cause is a facet joint. The biggest clue that we get is which movements of the neck are impacted. In facet joint presentations it may be painful to move/look to one side however almost completely fine/very minimal pain when looking the other way. For example you may be able to head check to the left with no issues but have difficulty head checking to the right. You may also be experiencing discomfort when looking at the ceiling however not when looking down at the ground.
This is due to the space between the joints narrowing/ closing off in these same side movements compared with the other side. Facet joints will usually affect one side and pain will often be one sided/ local to the region. Another big clue is your description of the type of pain you are experiencing. Patients will often describe their pain as a locking, jamming, pinching, tightness/stiffness or achy sensation.
As Myotherapists we can assess your ability to move actively AND passively. Which means we will watch you do the movements first, but if that doesn’t confirm our suspicions we can then do the movements for you by getting you to lie down on your back and (try your best to) let us control your movements. When we do this we are taking the muscles out of the equation and all that's left is your joints, if you still experience pain while we do the movements for you this is most likely a facet joint.
We will also palpate (feel/press on) the joints to check for tenderness at the joint itself, there are also a couple special orthopaedic tests that we can use to confirm that we are dealing with a facet joint. If all of that comes up positive for a facet joint pathology as well as the correct symptom profile for a facet joint pathology, then we have found the culprit of your pain!
One of the main reasons facet joints are so painful is the muscular guarding that comes with the condition. The main thing to remember here is that the body is very VERY good at protecting itself when something isn’t quite right. Therefore if your joint gets inflamed your nervous system is going to send messages to all of the surrounding muscles to “guard” and protect the injury as best as possible. This is what causes the really tight muscles and very limited range/ability to move your neck.
Another important thing to note is that your body will absolutely heal itself! Facet joints usually tend to be acutely painful for anywhere from 2-7 days, but usually do not hang around longer than 2 weeks. We call this a self limiting condition, which means it typically will resolve itself even without any intervention - however, most people like to speed up the process by getting it treated. Myotherapy is a great way to support the natural healing process and speed up your overall recovery from this condition.
As Myotherapists we are trained in being able to safely treat joint pathologies and facet joint irritation as part of our scope of practice. This means that along with treating the muscular component we can also use techniques such as joint mobilisations and joint MET to promote healthy joint function and healing.
Not sure what a joint mobilisation is?
Its a slow, low grade movement that we use to allow an irritated joint to begin moving freely again. Its not a “Crack!” of your neck!! The “cracking” technique is called a Manipulation or Adjustment, which is a full force, high velocity movement that only a qualified chiropractor or osteopath is able to provide for you, if that is more your style.
Facet joints also tend to respond well to dry needling on the affected side. We can needle the super tight muscles that are locking up around the joint to restore freedom of movement. This can help make the healing process quicker, and reduce the intensity of the pain while your facet joint recovers.
In terms of home care for facet joints here are some things we like to suggest patients with a joint irritation do at home:
- Chin tucks
Chin tucks are an amazing exercise that strengthen your deep cervical neck flexors and help to reduce pain while supporting joints.
This exercise can be done by making a double chin! (We know, super flattering!) Keep your eyes on a fixed structure at eye level in front of you and pull your head back to create that double chin. Be careful not to drop your chin to your chest or have your head tilted upwards, we want that nice neutral position and a slide back to execute this exercise efficiently.
- Hot or Cold???
Here's what we know about cranky facet joints in a nutshell! They hate the cold!! Avoid sleeping with the window open (especially coming up to winter) or even with a cold fan blowing near your face. Cold can aggravate the joints further so we recommend a heat pack and warm showers as well as wearing a scarf or jumper that covers the majority of the neck while outside in the colder weather.
- Anti-inflammatories
While dealing with an inflamed and irritated joint we often recommend a trip to the pharmacist to discuss anti-inflammatory options that you can use to manage pain and assist with reducing inflammation. A pharmacist can advise you on over the counter medications or creams that may be helpful to you to use during your recovery.
- Sleeping position
If you are a side or stomach sleeper, while the joint settles down we recommend trying to avoid sleeping on your stomach where possible. If you are a side sleeper with a tendency to roll onto your belly in the night try propping yourself up with a pillow to prevent you from rolling forward.
- Rest
Rest is going to be super important in your recovery as well as in how quickly you are going to recover. Low impact exercise is safe to engage in during this time such as walking or swimming however any exercise or sport such as basketball or football that may jolt the neck or re-aggravate the joint should be avoided where possible while you recover. Also try to avoid "checking" if it still hurts too frequently, repeatedly aggravating the area can make it take a bit longer to come good!
The above suggestions are just some of the things you can do at home to aid the recovery of an inflamed facet joint in the neck; however it is most beneficial to the healing process to be doing these in conjunction with physical therapy to get the best results. Myotherapy is a great form of physical therapy and we treat these cases and presentations frequently.
Its important to know that while this kind of pain can feel really horrible in its most acute stage, it usually won’t last longer than a few weeks, and likely even less if you get it treated very early on.
If you have any of these classic facet joint irritation symptoms don't hesitate to book an appointment and together we will create a treatment plan to get you and your facet joints healthy and happy again!
