LD Articles

Easily inflamed and very reactive to both unusual or in time to normal stresses on the neck, the facet joints generate symptoms in a variety of areas. Local tender areas and more widespread aching can occur in the upper arm, shoulder blade and shoulder areas and in the neck itself. As a reaction to this pain, spasm can develop in the neck musculature which adds to the overall problem by further compression of the joints and thereby increased pain and joint pressure. This spasm can become very severe and shows as hardness and tightness in the neck muscles which can be easily felt.

The overall delicate functioning of the neck can be badly disturbed by this muscle spasm, limiting its capacity to cope with sudden shocks. Muscles are more likely to remains contracted for longer than they should, rendering the neck more vulnerable to sudden jars and shocks. As the neck pain develops the person naturally guards their movement much more strongly which adds to the lack of normal movement as they limit arm activities. The interrelation of the thoracic and neck postures has important knock-on effects for neck pain syndromes as abnormal postures increase segmental stresses.

A lack of thoracic kyphosis can mean that the thoracic spine approaches its junction with the cervical spine above it in too vertical a position, forcing the neck to adopt a correspondingly more vertical posture than normal. The loads the neck bears are usually spread between the discs and the facet joints by the normal lordosis and if this is lost then increased loads may be thrown onto the discs, causing increased degenerative changes within them. The opposite, where an increased thoracic curve forces a correspondingly increased neck curve, is countered either by neck or lumbar extension.

With the poking neck syndrome occurring with an increased level of thoracic and cervical curves, the head is placed well forward of its support in the neck, forcing the main neck extensor muscles to over work to maintain their hold on head posture. The overuse of the upper trapezius muscles can cause trigger points to develop in the muscles, causing local and referred pain problems which can be very persistent. The overactivity of the upper part of the trapezius can cause a corresponding inhibition of the activity of the lower trapezius muscle which stabilises the scapula, enabling a good pattern of control for arm movement.

Many different ways of injuring the neck are possible but usually involve some straight up and down compression/tension forces and/or shearing or twisting forces which are more lateral in direction. Such injuries damage the outer walls of the intervertebral discs and this sets off degenerative processes in the disc which follow from the pain, muscular abnormalities of over and under activity, range of movement limitation and poorer disc nutrition. The extension muscles of the neck can contract more continuously and forcefully, pressuring the vertebral levels together abnormally. A thinned and degenerate disc may lead to a stiff segment but can also develop excessive mobility as its water content has decreased and its stability reduced.

With a degenerate segment often comes the growth of osteophytes, bony outgrowths which appear at the joint margins and along its ligaments. Osteophytes grow at segmental levels which are suffering abnormal movement forces and may be the bodys attempt to stabilise the segment by growing bone from vertebra to vertebra along the now less effective ligaments. Osteophytes may impinge on the spinal nerves to the neck or the back, causing severe arm pain, usually in older people. However, most osteophytes are a symptom of the degenerating disc level and not a problem in themselves, rarely needing surgical attention.

The facet joints of the neck are now vulnerable once the affected segment has stiffened with degenerative changes. Narrowing of the discs causes the facet surfaces to suffer increased contact forces as the segment closes down on itself. The movements which should be performed by the gradually more abnormal and stiff facet are passed onwards to other parts of the spinal system above or below the stiff segment. Facet joints which are normal can then start to suffer from the abnormal forces and change.