Behind the Neck Pain: What You Need to Know About Cervical Facet Joints
Behind the Neck Pain: What You Need to Know About Cervical Facet Joints
Understanding Cervical Facet Joint Arthropathy
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Cervical facet joint arthropathy is a common cause of neck pain among adults, impacting spinal stability and function. The facet joints, located on either side of the posterior vertebral body, are true synovial joints, encapsulated by a fibrous capsule and synovium, and lined with hyaline articular cartilage. These joints may also include meniscus-like structures that help improve joint congruency and biomechanics.
Each vertebral level contains a pair of facet joints that, alongside intervertebral discs (IVDs), control the movement of vertebrae and facilitate load transmission through the spine. They play a crucial role in maintaining alignment and allowing controlled movement in flexion, extension, and axial rotation. Notably, they bear up to 33% of dynamic and 35% of static spinal loads.
Anatomically, the orientation of these joints varies at different cervical levels. For instance, at C3–C6, the superior and inferior articular facets lie within the same vertical line, promoting uniform load transmission. However, at C2 and C7, they do not align vertically, causing forces to diffuse into adjacent structures like the laminae.
Pathophysiology and Clinical Relevance:
Degenerative changes in cervical facet joints are a significant contributor to chronic neck pain and can occur independently or before intervertebral disc degeneration in nearly 20% of spinal segments. These changes include cartilage degradation, joint space narrowing, osteophyte formation, and subchondral bone sclerosis.
Facet joint arthropathy has been associated with various spinal pathologies such as degenerative scoliosis, lumbar instability, disc herniations, and bony overgrowth. The condition's diagnosis remains challenging due to a high rate of false positives with imaging alone; thus, clinical examination and diagnostic blocks are often necessary for confirmation.
Physiotherapy Management:
Conditions that should be considered when diagnosing degenerative spondylolisthesis include lumbar compression fractures, spinal canal stenosis, herniated lumbar discs, spondylolysis, and facet joint arthropathy. These disorders often share symptoms like lower back pain and radiculopathy. However, a distinguishing feature of spondylolisthesis is that symptoms typically worsen with spinal extension, and in some cases, the condition may present without any symptoms at all.
Physiotherapy plays a vital role in managing cervical facet joint arthropathy, focusing on pain reduction, restoring function, and preventing further degeneration. Treatment is tailored based on clinical presentation and the individual’s functional limitations.
1. Pain Management and Mobilisation techniques
Techniques such as joint mobilization and soft tissue manipulation are commonly used to relieve pain and improve range of motion. Studies have shown that mobilizations can reduce cervical stiffness and muscle guarding while improving joint function (Gross et al., 2015).
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2. Postural Correction and Ergonomic Advice
Poor posture can contribute to cervical spine loading. Postural retraining, including ergonomic adjustments in daily life, is essential to offload the facet joints and reduce recurrence. Strengthening of postural stabilizers like deep cervical flexors can lead to long-term improvement in symptoms.
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3. Therapeutic Exercise
A targeted exercise program improves cervical strength, flexibility, and neuromuscular control. Exercises may include:
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Deep neck flexor activation
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Cervical range-of-motion exercises
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Scapular stabilization (to offload the neck)
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Proprioception training
Evidence supports that exercise therapy combined with manual therapy is more effective than either alone for managing mechanical neck pain (Kay et al., 2012).
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4. Electrotherapy Modalities
Modalities such as transcutaneous electrical nerve stimulation (TENS) and heat therapy may be used adjunctively to reduce pain and muscle tension, especially during acute flare-ups.
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5. Patient Education and Self-Management
Educating the patient on their condition, expected outcomes, and active participation in management leads to better adherence and long-term success. This includes guidance on activity modification and flare-up management.
By combining these strategies, physiotherapists can help patients regain function, minimize pain, and return to daily activities with improved confidence and safety.
References
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Cohen, S.P. and Raja, S.N., 2007. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology, 106(3), pp.591–614.
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Goel, A., 2013. Facet distraction spacers for treatment of degenerative disease of the spine: Rationale and an alternative hypothesis of spinal degeneration. Journal of Craniovertebral Junction and Spine, 4(1), pp.1–3.
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Gross, A., Miller, J., D'Sylva, J., Burnie, S.J., Goldsmith, C.H., Graham, N., Haines, T., Brønfort, G. and Hoving, J.L., 2015. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews, (9).
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Kay, T.M., Gross, A., Goldsmith, C., Rutherford, S., Voth, S., Hoving, J.L. and Brønfort, G., 2012. Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews, (8).
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O’Sullivan, P., Dankaerts, W., Burnett, A., Farrell, G., Jefford, E., Naylor, C. and O’Sullivan, K., 2006. Lumbopelvic motor control deficits in people with chronic low back pain: time to move on from back muscles?. British Journal of Sports Medicine, 40(5), pp.330–334.