What is a cervical facet sprain?
A cervical facet sprain also known as a “Wry Neck” and is very similar to a cervical facet strain. The cervical spine (neck) is made up of 7 connected bones called vertebrae. The vertebrae are connected to each other above and below through strong discs and joints on either side called facet joints. The discs protect the spine by acting like shock absorbers to distribute weight through the neck evenly. The facet joints on the other hand not only control but allow the movement of the neck. Think of the facet joints as the steering mechanism of your spine it is their job to determine what movements can be made and the extent of those movements. The disc in the middle and the facet joints either side form what professionals refer to as the “three joint complex” that makes the spine a strong and durable structure.
Individually these joints are susceptible to injury. A strong capsule that forms around the facet joint encapsulates it and prevents either boney ends from connecting or impacting. The capsule is filled a small amount of thick fluid called synovial fluid that acts as a cushion and there is a protective layer of articular cartilage that covers both boney surfaces. The cartilage, fluid and strong capsule allow the joint to move in a smooth, flexible manner. Ligaments surround the facet joint and are made of thick, tough, fibrous tissue. They overlap the joint to provide protection and stability. This stability is reinforced by the muscles that surround the joint. The muscles are not only there to create movement but they are strategically placed to protect the structures they support.
In essence, the facet joints in the spine are no different to the ankle joint and it is safe to assume everyone is familiar with the feeling of going over on their ankle and spraining it. The facet joints, like the ankle, have a limit to their movement which is termed the joints “end range of motion”. Normal, slow and gentle movements don’t harm the facet joints, however sudden and excessive movements like going over your ankle have the ability to stretch the joint past its end range. The result is damage to the facet capsule, ligament or surrounding muscles. When the capsule or ligament is injured then it is known as a cervical facet sprain and when the muscles surrounding the joint are injured then it is known as a cervical facet strain.
What does a cervical facet sprain feel like?
There is a sudden onset of pain almost immediately after or even during the injury and is coupled with intense muscles spasms creating neck stiffness. The pain is sharp and possibly burning to begin with, in some cases the sharp pain continues and in others it is replaced by an intense dull ache a day or two after the injury. Most commonly the symptoms are only felt on one side of the neck. However due to the three joint complex, the facet joint on the other side is usually also affected. The sharp pain may radiate down the side of the neck and into the tops of the shoulders, down into the upper back and also in some cases down the arm of the affected side. Symptoms are aggravated by sudden movements, tilting the head forward, rotating the head to the side and especially by looking up to the ceiling. Activities like sitting in one position for a long time and lifting can also aggravate pain levels.
It is extremely common for a sprain or strain to occur silently during an activity with the patient not yet aware that any injury has occurred. The only indication is a slight pain and stiffness which may be normal after certain activities. This happens most commonly in mild sprains and as long as you keep moving the muscles don’t have a chance to spasm in protection and the joints don’t stiffen up. In these instances, no symptoms are felt until the next day after you have slept in the same position for more than a couple of hours allowing the joints to stiffen and the muscles to spasm. Patients can awaken with extremely high pain and stiffness levels often feeling unable to lift their head of the pillow.
Why and when does a cervical facet sprain happen?
Facet sprains and strains can result from severe and sudden excessive movements, severe compressive forces or repetitive over stretching. The causative activity can be anything from sports contact like a rugby tackle to turning your head to quickly in reaction to someone calling your name. Alot of the time mild sprains are caused through repetitive strain like looking up whilst shearing the garden hedge and also spending too long looking down whilst reading a book. Other factors including poor posture, sedentary lifestyles and weak neck muscles can also contribute. One thing that affects many people is sleeping with a pillow too small or too big for them. If you sleep with a pillow too small for you your neck tilts down to meet the pillow overstretching the facet joints on one side of your cervical spine and compressing the other side and vice versa for a pillow too big. This is a common cause of a repetitive sprain/strain and accounts for many of the neck pain cases a GP will see.
How long does a cervical sprain take to heal?
Technically it can take injured ligaments and muscles up to six weeks to heal adequately. However most mild cases see pain levels start to ease from anything as early as 24 hours to up to 2-3 weeks. The pain levels are normally most severe to begin with, fading to a dull background ache towards the end. More severe sprains on the other hand can take anything from 3 to 6 weeks to completely recover. Even when pain levels start to ease, you must be careful returning to your activities as once the joint has been injured it is weaker and more susceptible to further injury. Many people experience recurring cervical facet sprains and strains, this is a strong indication of a weakened neck.
How will a cervical facet sprain be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis.
What treatments are there for a cervical facet sprain?
Your GP may prescribe a short course of anti-inflammatory painkillers to reduce and control the painful inflammation that occurs. Applying a covered ice pack to the area after the initial injury may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Avoiding all aggravating movements and postures is advisable, however complete rest is not. Try to move gently and often this will prevent stiffness levels from building in your neck. When you have to sit for a long time don’t try to over force a good or correct posture. Instead go with what is comfortable for you even if that is slouching a little, the key element is not to stay in that posture for too long. The golden rule basically is be a fidget!
The neck will be left slightly weakened after the injury. To prevent this weakness from progressing it is important to strengthen the muscles of the neck and upper back to avoid suffering from a recurring neck sprain. Starting with simple stretches and progressing to strengthening exercises will counteract any stiffness and weakness that has developed. Your therapist or GP will be able to advise you on appropriate exercises. A sprain will heal roughly within 6 weeks of its own accord, However many people seek out alternative treatment to speed up the recovery process. Manual manipulative and massage therapies have been seen to alleviate pain and stiffness levels quickly and help towards preventing future flare ups.