Irritability of inflamed or injured facet joints is high in terms of easily and quickly flaring up into pain when subject to unusual stresses, but then later can react badly even to normal stresses. The typical symptoms are local tenderness and aching throughout the neck, across the shoulder blades, over the neck/shoulder area and upper arms. All this pain can cause the muscles to go into spasm which compounds the problem by facet joint compression with consequent enhancement of the pain and joint forces. Some patients have severe neck muscle spasm which presents as tight, hard muscles.

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.

Increased cervical and thoracic spinal curves result in a typical poor posture, particularly in sitting, of the head poking well forwards of the shoulders and trunk, requiring high levels of force to be developed in the supporting musculature of the neck to keep the head held in space. The biggest and strongest muscle is the upper trapezius and when it is working too hard it can develop local tender and painful spots which can refer pain elsewhere and are known as trigger points. The lower trapezius muscles can correspondingly become underactive, leading to a reduced level of control of the shoulder, neck and arm complex.

Our necks can be injured in a series of different methods, either suffering sideways forces involving twisting or shearing or longitudinal compression forces, or both. The outer disc walls are vulnerable to such injuries and so begins the sequence of degenerative events in the disc, the pain itself followed by both inhibition and overwork of the muscles, loss of range of motion and limitation of disc nutrition. Pain worsening leads to the extensor muscles of the neck increasing the vertical pressures by over contracting, pushing the vertebral levels together more closely. Segmental disc narrowing may lead to stiffness but can also cause hypermobility of the segments as the disc, having lost water content and ligamentous integrity, loses its role in stability.

When a segment suffers degenerative changes bony outgrowths can appear at its margins along the ligaments, outgrowths known as osteophytes. Segmental levels with significant movement abnormalities will tend to show osteophytic changes, perhaps reflecting an attempt by the body to give increased segmental stability by building a bony bridge along the ligament or disc wall between the segments. The nerve roots in the neck or the back can be impinged upon by osteophytes which can cause severe arm or leg pain, requiring surgery. Surgical management is not a regular approach to most osteophytes which may well be asymptomatic.

One a stiff spinal segment has become established this has knock-on consequences for the more posterior facet joints. The facet surfaces are forced into more pressured contact as the vertebrae become closer together with the gradual narrowing of the disc. As a compressed facet becomes gradually damaged and stiff the movements that it should perform have to be performed elsewhere, either higher or lower, in the spinal column. This allows the stiff segment to cause problems in several areas of the neck which were previously unaffected.

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Facet joints are very irritable, which means when they are injured or inflamed they very quickly cause pain in response to initially abnormal, but later to normal, stresses. This causes aching and local tender spots in the neck, shoulder areas, over the shoulder blades and upper arms. Pain also leads to secondary muscle spasm which compresses the joints together further and amplifies the stresses and the pain. Muscle spasm can be very dominant in some neck problems and can easily be felt as tough, hard muscular contraction which is permanently present when the neck is under load.

The neck is a delicately functioning unit and this precise control is disturbed by muscle spasm which decreases its coping with unexpected forces. The neck shows an increased vulnerability to sudden applied forces when its muscles continue contracting beyond their allotted times. Guarding of the neck and self-limitation of movements occurs as the neck becomes increasingly painful and stiff, with the range of arm movements carefully limited. How the neck posture relates to the posture and mobility of the thoracic spine causes significant after affects for pain problems in the neck under stress.

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.

Neck injuries can occur in a variety of mechanisms, either the more vertical, compression like events or a sideways shearing and twisting incident. The disc outer walls are sensitive to these events and can be injured, starting the process of pain, muscular inhibition and muscular overactivity, reduced disc nutrition and loss of movement which progresses steadily to increased degenerative changes. As the pain progresses the neck extensor muscles add to the compression forces on the segments by becoming overactive, forcing the vertebrae closer together. Once a segmental disc has narrowed it may develop increased mobility rather than stiffness due to the reduction in strength of the disc unit when it loses its water content.

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 establishment of a stiff spinal segment in the neck forces the facet joints into an untenable position in terms of normal function. Compressed together by vertebral approximation secondary to disc narrowing, the facet surfaces suffer from the increased forces. The gradual joint damage reduces the movement available and this is picked up elsewhere in the spinal column, either lower down or higher up. This way previously normal joints can start to develop movement and structural abnormalities.