Facet Syndrome

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The pain of facet syndrome is like a fuzzy picture. When a picture is out of focus, you can only make out shadows and shapes but no actual details. Those with facet syndrome often describe their pain this way. They can't focus in and point to where it originates.

Neck pain, neck stiffness, headaches, shoulder pain and upper back pain are common symptoms of facet syndrome. The pain often worsens when people with the condition put their neck in certain positions (like rotated to the side, bent back or leaned forward), after they do activities that involve extending the neck and after they experience long periods of inactivity, like sleeping. It tends to get better throughout the day after tissues warm up.

Cervical facet syndrome can develop after patients suddenly turn their head, have a car accident, hold their neck in a particular position for a long time, have vertebral subluxations (stuck or misaligned joints), or develop poor posture or sleeping habits.

Some occupations, like secretarial positions, also make people prone to the condition, because of the neck's angle while people are looking at their computer or holding a phone to their shoulder. This angle places stress on the neck, which leads to inflammation and pain.

The pain comes from the cervical facet joints, which are joints at the back of the vertebrae (spinal bones) in your neck. When these joints are subluxated (stuck or misaligned) or irritated, local inflammation develops that can lead to subsequent irritation of surrounding nerves. When this happens, the irritated facet joints can refer (move) pain through these nerves to other areas of the body. The exact area the pain moves to depends on which facet joint is irritated. The second and third facet joints, for example, may refer pain into the back, while the sixth and seventh joints may refer pain into the shoulder blade area.

Facet syndrome is closely related to facet irritation, which is a similar condition that involves irritation and dysfunction of the facet joint. The difference between the two is that with facet irritation the pain is localized to the facet joints and with facet syndrome the pain is present in the joints as well as other areas.

Healthcare practitioners are experts at dealing with either of these conditions, and can usually relieve the pain of cervical facet syndrome. By seeing your healthcare practitioner regularly and beginning an exercise program, you can then help prevent the condition from returning.

Anatomy

When you picture the spine, think of the letter S. Three main sections compose this S, and the very top one, which is banana-shaped, is the cervical spine.

The cervical spine comprises seven bones, or vertebrae. All the vertebrae in the spine are linked like cars in a roller coaster, and facet joints located at the back of each vertebra provide the links.

In a roller coaster, the links allow the cars to function as a unit, turn corners and even go through loops. Like these links, the facet joints are supposed to move freely and smoothly, but problems begin when they become irritated or subluxated (stuck or misaligned) due to poor posture, everyday wear-and-tear or trauma ranging from a car accident to a sudden turning of the neck. All these can lead to stiff, swollen and painful joints. A roller coaster with stiff links becomes rigid and unable to perform. In your neck, stiff links can lead to local facet irritation or cervical facet syndrome.

Chiropractic care for this will depend on what factors caused the irritation. To determine that, your chiropractor will perform an assessment and take a detailed history of your condition. Once he or she pinpoints the problem, your care can begin.

Chiropractic Care

Cervical facet syndrome is fairly common, and almost completely treatable. Depending on the severity of the syndrome, it usually responds to chiropractic care within two to three weeks.

Once your chiropractor learns about the history of your condition and determines which facet joints are causing the problem, he or she will probably begin your care with adjustments, also called spinal manipulative therapy. Adjustments involve quick thrusts with the hands or with a device known as an activator tool to the affected joints, which restores joint motion, relaxes tight muscles, reduces pressure on nerves, increases blood flow and decreases inflammation. (If you are concerned about neck adjustments, please speak with your chiropractor about whether this is a safe method of care for you.)

With cervical facet syndrome, adjustments are the primary modality chiropractors use, and they usually help quickly. But if your cervical facet syndrome has caused additional problems, like muscle soreness, your chiropractor may use other techniques like cervical traction, trigger point therapy, muscular release, ultrasound and electrical stimulation.

Cervical traction works by producing a vacuum effect: your chiropractor gently pulls your neck upwards to take pressure and weight off the cervical facet joints. When he or she does this, the joints open up and inflammatory products get sucked out, helping to relieve pain.

Trigger point therapy works by returning malfunctioning muscles to their natural state. If your chiropractor uses this type of care, he or she will target muscle tissue that is in contracture, which is a state of excessive shortening that makes parts of muscles feel like taut bands or nodules. By applying pressure to these areas, called trigger points, for about 10 seconds, your chiropractor can return the muscle tissue to its appropriate length and remove irritating waste products, which decreases pain and relieves tension.

Another technique your chiropractor might use to promote muscle health is muscular release. The body sometimes compensates for weak or damaged muscles by laying down adhesions or scar tissue, which is supportive but doesn't have the same properties as regular tissue. By applying a sliding pressure to any of these areas, your chiropractor can remove or break down adhesions and scar tissue as well as promote the growth of healthy muscle.

Physiotherapeutic tools like ultrasound and interferential current (IFC) can also be helpful for cervical facet syndrome, as they decrease pain and promote healing. Ultrasound refers to any sound wave that has a frequency above the range the human ear can perceive. To produce these waves, chiropractors use a machine that channels electricity through a crystal located at the end of an applicator. The crystal vibrates in response to electricity, and the machine allows users to alter the electrical current to affect the waves' frequency. Depending on the frequency, this can increase blood flow, decrease pain, reduce muscle spasm, lessen nerve root irritation, break down scar tissue and speed healing.

IFC works in a similar way, but instead of sound waves it sends a painless electrical current through the skin into nerve fibers below, which causes the body to produce endorphins, its natural painkillers. By aiming the impulses at the cervical facet joints that are causing pain, your chiropractor can cause endorphins to interrupt the flow of pain signals from the affected tissues to the brain.

While all these types of care can help speed up the healing process, it's up to you to ensure the condition doesn't return. To that end, your chiropractor will probably prescribe an exercise program to improve muscular balance, posture, stability, strength and flexibility. By performing the exercises, making the appropriate lifestyle changes and seeing your chiropractor regularly, you can avoid a recurrence of the condition.

Facet Syndrome

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