The Human Neck " Part Three
The reduction in neck mobility exposes the capsules, fibrous bags around the joints, of the facet joints to traumatic stretching events. Turning the neck suddenly without conscious thought can push the joints to the limits of their movements, injuring the fibres of the capsular ligamentous tissues. This produces joint pain and scarring with increased capsular tightness as the healing process proceeds, making the joints tighter and less willing again to tolerate stresses. As the tight joints can occur in several parts of the neck this can cause a limitation of joint motion which doesn't become apparent until one day you find you can't turn your neck as you expect to.
Facet arthropathy causes pain from several sources: the local pain from the abnormal facet joint itself; referred pain from this source and the resulting muscle spasm. The joint pain itself is fairly closely localised and may sometimes be felt by one's own fingers as a tight lump. Referred pain is often felt as an ache which is difficult to clearly define, its just an annoyingly vague but troubling pain in the arm, shoulder or thoracic area. These symptoms can eventually become important and disturb sleep, which has knock-on effects such as tiredness, irritability, increased muscle tenderness, anxiety and depression.
The facet joint can suffer a sudden, painful and relatively minor injury resulting in what is called an acute wry neck, perhaps from vigorous hair drying with a towel, jarring oneself or looking suddenly round to one side. If we sleep in an odd position for a while we can also wake up with this neck pain problem. The onset is usually quick and unexpected as our facet joint locks as the movement surprises our controlling muscular systems, perhaps spraining the easily irritated facet joint capsule or pinching the synovial membrane between the surfaces. Sudden, intense neck pain from this induces strong spasm of the neck muscles and secondary pain.
The result for the patient of an acute wry neck is usually a severe, mostly one-sided neck pain and significant limitation of movements. Muscle spasm may be very severe and the head may be held at an unusual angle or part way into a movement to one side. The person guards their movements very carefully and moves slowly, desperately trying to avoid a sudden movement which will cause an increase in the compressive forces of muscle spasm and so the severe pain. Getting into bed at night or getting up in the morning can be very difficult with holding the head with the hands to cope as the muscles attempt to stabilise the neck.
Early manipulation of a locked cervical facet joint by a chiropractor, osteopath or manipulative physiotherapist can release the joint, perhaps by gapping the joint surfaces, releasing the trapped membrane or by allowing the joint to realign. Typically the recovery period takes longer, with a few days of painkillers and anti-inflammatories needed before the pain begins to settle down and movement starts to return. Joint mobilisations, a less forceful technique than manipulation, are very useful to ensure the joint does not harbour any long-lasting movement abnormalities which could predispose to recurrence or perpetuation of neck pain.
A fast onset of neck pain is not always due to facet lock but can, with a gradual onset taking several days, be indicative of a disc related or inflammation related nerve root insult. An initial facet joint injury may in some cases not settle down well, allowing fluid to collect around the nerve root exit from the spinal canal which slowly thickens and forms into scar tissue and can stick down the nerve to the surrounding structures. Tethering the nerve exposes it to risk of injury due to the fact that nerves are very sensitive to stretch in particular, which can result in an agonising pain syndrome developing in the shoulder, arm and neck.
Although neck pain may not be the major presenting part of the problem, patients often indicate there were some warning signs from their neck previously, with the neck or arm being less predictable and reliable on various activities. The precipitating reason for the full syndrome may be something small, just in the right direction to stress the nerve.
Facet arthropathy causes pain from several sources: the local pain from the abnormal facet joint itself; referred pain from this source and the resulting muscle spasm. The joint pain itself is fairly closely localised and may sometimes be felt by one's own fingers as a tight lump. Referred pain is often felt as an ache which is difficult to clearly define, its just an annoyingly vague but troubling pain in the arm, shoulder or thoracic area. These symptoms can eventually become important and disturb sleep, which has knock-on effects such as tiredness, irritability, increased muscle tenderness, anxiety and depression.
The facet joint can suffer a sudden, painful and relatively minor injury resulting in what is called an acute wry neck, perhaps from vigorous hair drying with a towel, jarring oneself or looking suddenly round to one side. If we sleep in an odd position for a while we can also wake up with this neck pain problem. The onset is usually quick and unexpected as our facet joint locks as the movement surprises our controlling muscular systems, perhaps spraining the easily irritated facet joint capsule or pinching the synovial membrane between the surfaces. Sudden, intense neck pain from this induces strong spasm of the neck muscles and secondary pain.
The result for the patient of an acute wry neck is usually a severe, mostly one-sided neck pain and significant limitation of movements. Muscle spasm may be very severe and the head may be held at an unusual angle or part way into a movement to one side. The person guards their movements very carefully and moves slowly, desperately trying to avoid a sudden movement which will cause an increase in the compressive forces of muscle spasm and so the severe pain. Getting into bed at night or getting up in the morning can be very difficult with holding the head with the hands to cope as the muscles attempt to stabilise the neck.
Early manipulation of a locked cervical facet joint by a chiropractor, osteopath or manipulative physiotherapist can release the joint, perhaps by gapping the joint surfaces, releasing the trapped membrane or by allowing the joint to realign. Typically the recovery period takes longer, with a few days of painkillers and anti-inflammatories needed before the pain begins to settle down and movement starts to return. Joint mobilisations, a less forceful technique than manipulation, are very useful to ensure the joint does not harbour any long-lasting movement abnormalities which could predispose to recurrence or perpetuation of neck pain.
A fast onset of neck pain is not always due to facet lock but can, with a gradual onset taking several days, be indicative of a disc related or inflammation related nerve root insult. An initial facet joint injury may in some cases not settle down well, allowing fluid to collect around the nerve root exit from the spinal canal which slowly thickens and forms into scar tissue and can stick down the nerve to the surrounding structures. Tethering the nerve exposes it to risk of injury due to the fact that nerves are very sensitive to stretch in particular, which can result in an agonising pain syndrome developing in the shoulder, arm and neck.
Although neck pain may not be the major presenting part of the problem, patients often indicate there were some warning signs from their neck previously, with the neck or arm being less predictable and reliable on various activities. The precipitating reason for the full syndrome may be something small, just in the right direction to stress the nerve.
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in Leeds, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.