Cervical Facet Syndrome and Exercises to Help the Pain

What is Cervical Facet Syndrome?

Cervical Facet Syndrome happens when the facet joints in the neck begin to deteriorate. Facet joints, also called zygapophyseal joints, are small joints throughout your spine that allow your body to move and handles the force loads placed on the body. Facet syndrome is due to osteoarthritic changes in one or more vertebral facet joints. Symptoms of facet joint pain will vary for each person. As the joints in the neck start to deteriorate or break down you will begin to have issues. The most common symptom being neck pain. Often times, as the degeneration continues it will add strain on your discs, ligaments, tendons, and muscles. As this occurs you will start to experience even more symptoms.

In the beginning you will have localized pain at the specific level involved. This pain is typically felt on the side of the neck or back of the neck. Over time you will have more general soreness and will develop decreased range of motion. As everything continues to get tighter the headaches start to increase as well. As it begins to further breakdown and irritate the surrounding structures you can also begin to have disc-based pain or nerve pain. Unfortunately, cervical facet joints degenerating is becoming an even bigger issue than ever before!

What Causes Cervical Facet Joint Pain? 

There are a lot of contributing factors, but number one is going to be poor posture. This is the case for any facet joint syndrome, but especially in the neck. If you had to guess what the number one cause of that is what would it be? If you guessed cell phones you are 100% correct. It actually has its own name now called “text neck”.

What happens is you look down for an extended period of time which causes a lot of strain on the neck. As the joints begin to fail under the constant added pressure your curve will begin to straighten (forward head posture). Your range of motion quickly deteriorates and through imaging, either a CT scan or MRI, your doctor will go on to tell you that you have degenerative disc disease (DDD) or facet joint degeneration. Often times they come hand in hand.

Once your cervical spine begins to have issues your body will try to compensate to attempt to handle the strain. The next common problem that’ll pop up is shoulder pain because your shoulder blades become restricted. This will also cause your upper back to lock down and become restricted. That eventually will make it all the way down to the lumbar spine and trigger lower back pain.

These pains can come at first as dull aches and eventually progress to muscle spasm. The degenerative changes continue to increase over time causing a lot of pain throughout the entire body, muscle weakness, and nerve radiating pain. Once the degeneration becomes severe enough and affects the spinal nerves you will start to notice you lose the ability to function. What once was an easy daily routine becomes a hard daunting task. You begin to get overwhelmed and will start to ask yourself what can I do to get out of this day-to-day torture? Hopefully this is where we can help you!

Pain Relief

If you are reading this article, you probably already have chronic neck pain. You’ve probably googled enough to self-diagnose yourself with facet syndrome, cervical disc, or degenerative problems in general. Lets discuss some options you have to decrease your pain!

Anti-inflammatory medications

You’ve probably already tried this and have used this as a method for a while. Things like Advil, Tylenol, etc. are a great temporary relief but they are just hiding your issue and allowing the degenerative changes to get worse without you knowing it. On top of the fact that anti-inflammatory meds are horrible on your kidneys and liver. Overall, these aren’t a great long term option for you. It’s a good temporary aid to help you feel better but lets focus on correcting the issue.

Physical therapy

A physical therapist will be able to do a physical examination on you to determine all your problematic areas. They will be able to assess your static posture as well as your functional movement patterns. A good therapist will be able to easily determine your weak areas and give you specific exercises you can do to correct it.

As a chiropractor I am a huge fan of physical therapy. Majority of people have flexor dominance. Whether you notice that as forward head posture, rounded shoulders, “hunch back”, flat upper back, sway back, dropped foot arches, etc. What I love about physical therapist is they can give you exercises that are the best way for your specific body to heal and strengthen.

Chiropractic

No big surprise as a chiropractor that I’d highly advise you to get adjusted but lets talk about why it’ll help you! First off, your spinal column from your neck all the way down to your pelvis is incredibly important. It protects all the nerves in your body that allows you to move and experience this world. More importantly those different joint surfaces actually allow you to move through this world.

When your body sends you pain signals it is saying hey, I’m struggling to communicate and I have dysfunction. The pain becomes present after the problem has been there for a long time and your body can no longer compensate. The pain is the final SOS from your brain saying please help me.

A chiropractor will do a detailed exam and determine these areas of interference in your spine. They will develop conservative treatments that will help to rebalance your spine. When your chiropractor adjusts you, it helps the body to remove the subluxation (interference in the spine). This will send a boost of signals to your brain saying hey I’m right here and now I’m functioning properly. As you go through your treatment plan your body begins to stabilize and strengthen. This will then turn off the SOS signal because now it’s no longer needed.

The adjustment is going to help the acute or chronic pain you have by releasing endorphins. It will increase your range of motion by freeing up the stuck joints. The best part, in my opinion, is that it turns your “light bulb” back on! Your brain will start properly communicating to the rest of the body, and the body is sending back the appropriate signals as well. As you free up the structures in your spine and do some simple exercises which we will talk about in a little bit, you can actually begin to reform the cervical curve that you lost.

Cold Therapy

Cold therapy is not one of my go to therapies. However, if you are having a lot of pain using an ice pack to decrease the inflammation in the area can help to numb the pain for a short period of time. I will say though if you just went to physical therapy, worked out, got adjusted to use heat that day instead of ice. Ice is amazing at pushing out inflammation and decreasing the blood to that area. However, don’t forget if you’re trying to correct an issue for that short little bit after the therapy you actually need that blood flow to heal.

Massage Therapy

When you have facet pain or even discal pain your muscles are going to become tight and locked down. Any time you have something going on with the bones the soft tissue around it will always have problems. With cervical facets being involved one of the biggest muscles that’ll lock down is the trapezius muscle.

Your traps help to stabilize and move the shoulder blades as well as extends the neck. The trapezius muscle is also a big factor in maintaining the proper slope of the neck. As your facets degenerate and you lose the curve in your neck, the traps have to work much harder which is why they spasm and create trigger points. If you are trying to correct the posture having these trigger points and spasms addressed as you are going through corrective care is incredibly important. Plus, the added benefit of decreasing pain is huge!

Laser Therapy

Cold laser and infrared laser therapy is picking up in popularity. These lasers hit at a specific wavelength which will stimulate the cells in the area and help to reduce the oxidative stress in the area. (Oxidative stress is an imbalance between free radicals and antioxidants within your body. With accumulation it will cause damage to surrounding structures. Oxidative stress has a significant relation to the degeneration process). The laser therapy will speed up your healing rate, lower inflammation, decrease pain and increase the overall function of the treated region.

Ozone Therapy

This is another up and coming therapy. With ozone therapy your doctor can inject ozone directly into the effected joint. It is a minimally invasive procedure that injects Ozone (a molecule made up of three oxygen atoms) into the joint. It has shown to relieve the pain and some doctors have seen it help repair some of the damage within the joint itself by inducing healing. These facet joint injections have also shown to decrease the oxidative stress in the area.

Cervical Curve Correction

For cervical facet syndrome or really most neck conditions (even some lower body conditions) can benefit from curve correction. It’s important to get adjusted to make sure your joints are moving and then you can buy a curve correction device on amazon.

You will want to find a flat surface you can lay on (not the bed). If you want to lay on the floor I’d advise a yoga mat. You will start with 1-2 minutes in the beginning. If you get up and you are sore then you will cut the time back by 30 seconds. When you get up and it is not tender then the next day you will increase the time that you lay on it for another 30 seconds or minute. If you get sore go back to the original time for another 2 days and try again. You want to eventually get up to 20 minutes a day on this device. The curve corrector I advise for my patients can be found here.

If you have a really inflamed neck it will take a while to progress your time. Do not rush the process! It seems like it is very minimal on the neck but it is challenging all of the small muscles, ligaments and tendons in your neck. On top of the fact that it is trying to get your neck curve to go back to the way it is supposed to be. This correction should not be painful. If it is discontinue and check with your chiropractor or medical doctor for more advice.

Losing Weight

I know nobody wants to hear this as an option to get out of pain. If you will remember your facets will handle force load placed on the body. Unfortunately, the more weight we put on the more it will stress our facets and other structures in the spine. Excess weight plays a big role in skyrocketing the osteoarthritis of the spine and other joints in your body. Your body weight can have a large impact on your facets and overall health so changing up your diet and losing weight will not only decrease the inflammation in your body overall, but will take off the additional stress added onto your joints.

Facet Joint Block

If your pain is severe and you’ve tried a lot of other options and it isn’t working your doctor might advise a local anesthetic. This is considered a minimally invasive procedure performed by your medical doctor. They will inject the anesthesia directly into the effected facet and it will help reduce the inflammation which will decrease your pain.

The best thing that comes from these is that it will allow you to tolerate the physical therapy, chiropractic, massage, and corrective exercises. I’ve had plenty of patients that are willing to do all the things to correct their posture to correct the facet syndrome, but they simply can’t tolerate the pain that comes from it. The block gives you enough relief for an extended period of time so you can put in the work and fix the issue.

Steroid Injections

It’s always a good idea to talk to your doctor and determine if steroid injections are right for you. A lot of doctors jump to using steroids, but if used too much it will actually damage the cartilage within the joint. All of your facet joints are lined with articular cartilage. The cartilage is surrounded by a joint capsule filled with synovial fluid. With facet syndrome this cartilage is already breaking down, and the synovial joints are already struggling. For me it sends up the red flag. It’s hard for me to say ok use the steroid when it can further break down the cartilage. However, if it is a one-time thing your doctor wants to try first it can definitely provide you a little bit of time to start correcting the issue.

Facet Joint Fusion

Surgical procedures are going to be the most invasive option you have. This is the one we want to avoid at all costs! Once you fuse these joints there’s not much else you can do, and you’ll lose that mobility for the rest of your life. This procedure is going to be more common in the elderly population because the degeneration is more severe. However, I am starting to see this surgery becoming more popular in the younger population as well, which absolutely breaks my heart. Once the joints become severely degenerated unfortunately it becomes the only option you have to relieve the pain. So, lets not let it get to this point and go over the things you can do now to correct your poor posture.

Exercises to have correct posture

This article is focusing on facet syndrome but there are a lot of other spine conditions that will benefit from these exercises, so if you don’t have facet syndrome you can still try out these exercises to see if it will help your pain.

Isometric Neck Exercises

Facets again are responsible for our ability to move. When your facets are highly inflamed and painful one of the first things you can do is just start them moving through the normal ranges of motion. As far as exercises go this one is a very gentle exercise, so it’ll prevent you from flaring up.

With these exercises you need to be weight bearing to load the joints. I recommend starting from a seated position and then you can graduate to a standing position when you are comfortable.

Flexion

With your head in a neutral position (looking forward) you will press your palm against your forehead and gently press your head into your hand. You will hold that for 10 seconds, relax it for 30 seconds and then do 5 more repetitions.

Extension

With your head in a neutral position you will press your palm to the back of your head and gently press your head into your hand. Hold for 10 seconds, relax for 30 seconds and then repeat 5 more times.

Lateral Bending

With your head in a neutral position you will place your right hand to the right side of your head and place pressure against your hand as if you are trying to bring your right ear towards your right shoulder. Hold for 10 seconds, relax for 30 seconds, and then repeat 5 times. (Do the exact same for the left side)

Rotation

With your head in a neutral position you will place your right palm to the right front side of your head and you will stimulate the motion of your head turning to the right. Hold for 10 seconds, relax for 30 seconds, and repeat 5 times. (Do the exact same for the left side).

When there is no pain or discomfort with your head at neutral you can move your head to 15-45 degrees in the direction you are challenging and run through the exercises again. This is a very gentle exercise that will help you to regain your range of motion without causing irritation to your facets.

Check out Saint Luke’s website for more info https://www.saintlukeskc.org/health-library/neck-exercises-neck-isometrics

Posture correction can take a long time to correct. It unfortunately isn’t something you can do for a week and see massive improvements. I like telling my patients to take a picture before they start their therapy. The correction happens a little at a time, so it can be discouraging. If you take before pictures, then you can compare it throughout your journey to see just how far you have come. Plus, it’s just fun to see your starting position of your posture and compare it to your final good posture picture!

Scapular Mobility Exercises

If you remember your trapezius muscle is the muscle that forms the slope of the neck and is responsible for scapula (shoulder blade) movements. When your neck is having issues it’s pretty much a guarantee that your scapula is as well. A big component to allowing the neck to perform proper range of motion is to also get the scapula moving properly. Joint mobilization of the scapula is also a great place to start if doing neck movements is too painful. Go to this website for a great detail description on how to perform these exercises. https://www.flexibilityrx.com/shoulder-mobility-exercise-scapular-wall-slides/. You can also watch this video on youtube that shows you how to get the full range of motion out of your shoulderblades https://www.youtube.com/watch?app=desktop&v=PI4v0RfA708.

Aerobic Exercise

This can be any physical activity that uses your body’s larger muscle groups in rhythmic and repetitive movements. While this isn’t going to correct your cervical curve, it will get you moving! One of the biggest components of degeneration in general is from lack of movement, so this gets you up and using your muscles. This will activate your extensors and help to decrease your flexor dominance. Just getting up and moving can have an impact on changing your posture. Your posture muscles are your extensor muscles so the more you use them the more your cerebellum (what controls your posture) will continue to activate them.

Core Strengthening Exercises

Everyone thinks of their abdominal muscles when they think about your core. While Your abs are definitely a piece of your core, they are responsible for truncal flexion. With facet syndromes you typically already have a flexor dominance, so to combat this you want to focus on extension. The best core muscle you have is actually your gluteus maximus (Glute Max). It is your largest postural muscle that holds you up against gravity. If you can’t activate your glutes, it is very likely that you can’t activate your other core muscles especially the important back muscles.

Glute Bridges

This is an easy exercise you can perform at home. You will lay flat on the ground and bring your knees to 90 degrees with your feet flat on the ground. You will slightly lift off the ground while squeezing your butt cheeks. Everyone wants to lift up all the way off the ground. This isn’t necessary though and often times with facet syndrome if you raise your bottom too far up you will actually flare your condition, so if it hurts to perform it you are going too high!

Superman’s

This is another great yet mild exercise you can do that is great for the facets. You will lay on your stomach with your arms stretched out in front of you. You will go into extension bringing both your arms and legs slightly of the ground. As you extend back also bring your neck in extension as if looking in front of you. This will activate all of the extensor muscles as one large group together.

Bird Dogs

You will start on your hands and knees. While keeping your core tight (suck in your stomach) you will elevate the back left leg and the right arm. Then you will switch and do the other side. It helps to also add in neck extension with this exercise each time you bring your arms up.

As with any new exercises you do you are going to be sore. Make sure you start out slowly and you can always increase your number of reps over time. Ideally running through the exercises with 15 reps each three times a day is a great goal. However, don’t start there or you definitely won’t like me come tomorrow morning.

Conclusion

One of the important things to remember is that your synovial joints, whether it is the spine or anywhere else in the body, are dependent upon movement to stay healthy. There are a lot of examples of exercises you can do to help! If it is too overwhelming in the beginning start with just walking. You would be surprised to find that just walking could decrease your pain level and start to improve your posture.

There are a lot of treatment options that you can work through. What works for you may not work for the next person, but keep trying and figure out the movements that are best for you. Healthy facet joints glide through all the movements. Yours probably haven’t been healthy in a while so be patient, stay consistent, and don’t give up on your journey. These gentle exercises provided will help you to get that chronic pain down, but most importantly help you get back to enjoying your normal activities.

Self care often times is one of the hardest things for us to do! We live in a world where we feel selfish for taking time for ourselves. However, be selfish now and then you’ll be able to give even more of yourself once you are feeling better.

You can also check out Best effective chiropractic neck exercises and stretches for even more help on your healing journey.

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