Facet joint sprain

What is a facet joint sprain?

A facet joint sprain is a common condition characterized by damage or tearing of the connective tissue (such as ligaments, cartilage and joint capsule) of one of the facet joints of the upper back. 

The spine comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the discs centrally (figure 1). These joints are designed to support body weight and enable spinal movement. 

Figure 1 – Thoracic Facet Joint Sprain Anatomy

Each facet joint comprises of smooth cartilage which lies between the bony joint surfaces cushioning the impact of one bone on another. Strong connective tissue also wraps around the bony ends providing support to the joint. During certain movements of the spine, stretching or compressive forces are placed on the facet joints. If these forces are excessive and beyond what the facet joint can withstand, injury to the facet joint may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. This condition is known as a facet joint sprain.

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Causes of a facet joint sprain

Facet joint sprains typically occur during excessive bending (i.e. forwards, backwards or sideways), lifting or twisting movements. They may occur traumatically or due to repetitive or prolonged forces. They may also occur due to being in poor posture (figure 2) for prolonged periods of time (e.g. sitting slouched or sleeping in the foetal position) or working with the arms in front of the body (e.g. house work) particularly in poor posture.

Figure 2 – Poor posture 

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Signs and symptoms of a facet joint sprain

Patients with this condition may experience a sudden onset of back pain during the causative activity. However, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms are typically felt on one side of the spine and muscle spasm may be experienced around the affected joint. Occasionally pain may be referred into the shoulder blade, ribs, chest, or upper limb. Symptoms may be exacerbated with activities that involve twisting, lifting, arching backwards, bending forwards or sideways, sitting for prolonged periods of time (particularly in poor posture), coughing or sneezing.

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Diagnosis of a facet joint sprain

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a facet joint sprain. Investigations such as an MRI or CT scan may be required to confirm diagnosis.

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Exercises for a facet joint sprain

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily once the physiotherapist has indicated it is safe to do so and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.

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Initial Exercises

Shoulder Blade Squeezes

Begin sitting or standing tall with your back straight (figure 4). Squeeze your shoulder blades together as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Hold for 1-2 seconds and repeat 10 times provided there is no increase in symptoms. 

Figure 4 – Shoulder Blade Squeezes 

Rotation in Sitting

Begin sitting tall, with your arms across your chest. Keeping your legs still, gently rotate to one side as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 5). Hold for 1 - 2 seconds and repeat 10 times to each side, alternating sides, provided the exercise is pain free.

Figure 5 – Rotation in Sitting (left side)