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.

There are several potential sources of the pain of facet arthropathy: the muscle spasm which develops in response to the pain; the referred pain in the shoulder and arm from the pathology in the neck and the local pain of the abnormal facet joint. It’s possible to feel the particularly tender area of a localised irritable facet joint in the neck while the referred symptoms are much more difficult to describe, being a vague and poorly defined ache in the arm or shoulder areas. Worsening of the neck pain can then interfere with sleeping, leading to added problems such as irritability, tiredness, 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.

An osteopath, physiotherapist or chiropractor can manipulate a locked facet joint early on in the problem with complete relief in some cases. The mechanism may be that the separation of the joint surfaces by the manipulation allows the realignment of the joint or releases the trapped tissue. More often the time to recovery is longer with anti-inflammatories and painkillers necessary for some days until the pain reduces and movements can be restarted. A less severe therapy technique, joint mobilisations, can be used later to clear the joint of any long-term abnormalities of its movement which could make the pain come back again later.

A sudden onset of neck pain, or more commonly a slower onset over a few days, can be an indication not of a facet joint problem but a nerve root irritation perhaps secondary to inflammatory changes or a disc protrusion. If a facet joint injury does not settle early or well an inflammatory exudate can form around the nerve root as it exits the spinal cord through the narrow channel, gradually developing into scar tissue as it heals. Nerve react particularly badly to stretch out of all possible mechanical inputs, and if a sudden stretch is put on the tethered nerve this can set off an inflammatory process resulting in severe and very unpleasant neck, shoulder and arm pain.

Neck pain is typically not a major part of this condition, with patients often giving a history of the neck and arm being unreliable or painful in small ways prior to onset. The full nerve root compression or irritation syndrome may be brought on by a minor mechanical stress which targets the specific vulnerability of the nerve pathology.

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