Sports Medicine
Sports Injury Prevention & Rehabilitation

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Facet Joint Sprain -Neck

(Also known as Neck Sprain, Sprained Neck, 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. 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.

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).

Diagnosis of a facet joint sprain
A thorough subjective and objective examination from a physician 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 physical therapy. One of the key components of treatment is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free (a postural support or postural taping may be required). 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 comfortable and does not increase symptoms).
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.
Patients should follow RICE in the initial phase of injury. RICE is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). RICE for a facet joint sprain primarily involves resting from aggravating activities (this may include the use of a postural support or postural taping) and regular icing. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
It is also important for patients with this condition to perform early movement, strength and postural exercises to prevent stiffness and weakness from developing and to ensure the neck is functioning correctly. The treating physical therapist 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 physical therapy. 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.

Physical therapy for a facet joint sprain
Physical therapy 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 physical therapist 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 physical therapy 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.