What is a facet joint sprain?

A facet joint sprain is a common condition characterized by damage or tearing of the connective tissue (such as ligaments, cartilage and joint capsule) of one of the facet joints of the neck.

The 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).

Figure 1 – Anatomy of a Facet Joint Sprain of the Neck

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.

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Causes of a facet joint sprain

Facet joint sprains typically occur during excessive bending (i.e. forwards, backwards or sideways), lifting, slouching, or twisting movements of the neck. This may occur traumatically due to a specific incident (e.g. in tackling sports, such as rugby or wrestling) or due to repetitive or prolonged forces. They may also occur during sleeping particularly in poor posture (figure 2).

Figure 2 – Poor posture

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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, shoulder blade, 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).

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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 and rule out other conditions.

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Prognosis of a facet joint sprain

The recovery time following a facet joint sprain may vary from patient to patient depending on the severity of injury and 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.

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Physiotherapy for a facet joint sprain

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

• soft tissue massage
• joint mobilization or manipulation
• traction
• electrotherapy (e.g. ultrasound)
• postural taping
• postural bracing
• dry needling
• the use of a lumbar support 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

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Contributing factors to the development of a facet joint sprain

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

• poor posture
• poor ergonomic set-up
• neck or upper back joint stiffness
• a sedentary lifestyle
• poor core stability
• muscle weakness (e.g. the deep neck flexors)
• muscle tightness (e.g. the suboccipital muscles)
• inappropriate lifting technique
• a lifestyle involving large amounts of sitting, bending, slouching or lifting.
• Inadequate recovery periods from repetitive or prolonged neck movements (such as bending, slouching or twisting of the neck)
• Use of an inappropriate pillow during sleep

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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.

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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, the initial and intermediate exercises should be performed 3 - 5 times daily, whilst the advanced exercises should be performed twice daily.

All exercises should only be performed provided they do not cause or increase symptoms.Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should only take place provided there is no increase in symptoms.

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Initial Exercises

Chin Tucks

Begin sitting or standing tall with your back and neck straight, shoulders should be back slightly (figure 4). Tuck your chin in as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Keep your eyes and nose facing forwards. Hold for 2 seconds and repeat 10 times provided the exercise is pain free. Repeat 3 - 5 times daily.

Figure 4 – Chin Tucks

Shoulder Blade Squeezes

Begin sitting or standing tall with your back and neck straight (figure 5). Squeeze your shoulder blades together as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Hold for 5 seconds and repeat 10 times provided the exercise is pain free. Repeat 3 - 5 times daily.

Figure 5 – Shoulder Blade Squeezes

Neck Rotations

Begin sitting with your back and neck straight and your shoulders back slightly. Turn your head looking over one shoulder as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 6). Then repeat the exercise turning your neck in the opposite direction. 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. Repeat 3 - 5 times daily.

Figure 6 – Neck Rotations (right side)