Facet joint pain after whiplash: how it's diagnosed

What are facet joints and why do they get hurt in a crash?

Each segment of your spine has two facet joints, one on each side at the back. They're about the size of a thumbnail. They guide motion and keep the spine from twisting too far. Like a knuckle, each one has cartilage, a lining, and a capsule that holds it together.

In a rear-end collision, the body is pushed forward while the head lags behind for a split second. The neck bends into an S shape before it whips forward. That motion squeezes the back of the neck and can stretch or pinch the facet joint capsules. Research on whiplash has pointed to the facet joints as one of the most common sources of neck pain that lasts months after a crash.

The lower back can be affected the same way, especially when the body twists at impact or the seat belt holds the pelvis while the trunk keeps moving.

What does facet joint pain feel like?

Facet pain has a recognizable pattern, though no single symptom proves it:

• A deep, dull ache on one or both sides of the spine
• Pain that's worse when you tilt your head back, look over your shoulder, or lean backward
• Stiffness in the morning or after sitting, which loosens with gentle movement
• Tenderness when someone presses beside the spine
• Pain that spreads into the shoulder blade, the back of the head, or the buttock and upper thigh

Facet pain usually doesn't shoot below the elbow or knee, and it usually doesn't cause numbness or weakness. Those symptoms point more toward an irritated nerve root, which needs its own workup.

Headaches that start at the base of the skull are common with upper neck facet injuries. Doctors call those cervicogenic headaches.

Why doesn't my MRI show what's wrong?

MRI is excellent at showing discs, nerves and the spinal cord. It's less helpful for facet pain. A sprained facet capsule often looks normal on MRI. On the other hand, many adults have facet arthritis on imaging with no pain at all.

So an MRI can rule other problems in or out, such as a large disc herniation, a fracture or nerve compression. It can't confirm that a specific facet joint is your pain source. That's why facet pain is diagnosed with a combination of your history, a physical exam, and a test.

How do doctors test for facet joint pain?

The standard test is a medial branch block. Medial branches are the tiny nerves that carry pain signals from each facet joint.

Here's how it usually works:

• You lie face down, and the skin is cleaned and numbed
• The doctor uses live X-ray to guide a thin needle next to the medial branch nerves at the suspected levels
• A small amount of local anesthetic is placed there
• Afterward, you do the movements that usually hurt and record your pain for the next several hours

If your typical pain drops a lot while the medicine works, the treated joints are likely involved. Because a single block can give a misleading result, many doctors confirm with a second block on another day.

An intra-articular facet injection, which places medicine inside the joint, is another option some doctors use, sometimes with a steroid.

What if the blocks work?

A positive result gives you and your doctor options. Some people get more than short-term relief from the blocks and need nothing further. For others, radiofrequency ablation is the next conversation. It uses heat to quiet the medial branch nerves for months at a time.

Either way, movement stays at the center of care. Physical therapy for neck and core strength, posture work and a home exercise program help protect the joints as they recover.

What if the blocks don't work?

That's useful information too. It means the facet joints probably aren't the main problem, and your doctor can look elsewhere: the discs, a nerve root, the muscles, the sacroiliac joint, or a brain injury that's contributing to headaches. Ruling things out narrows the search.

How long does facet pain last after a crash?

Many people improve within weeks to a few months with activity, medication and physical therapy. A smaller group still has pain at six months or longer. Facet joints are a common reason in that group. If your pain hasn't improved after several weeks of conservative care, ask about an evaluation by an interventional pain specialist rather than waiting it out.

Can I keep working and exercising?

In most cases, yes. Gentle, regular movement usually helps more than rest. Avoid positions that keep your head tilted back for long stretches, like overhead work, until you've been evaluated. Adjust your screen to eye level, take breaks from driving, and sleep with a pillow that keeps your neck neutral.

Where can I get evaluated for facet pain in Texas?

SpineLUX interventional pain management and spine care clinicians evaluate accident-related neck and back pain and decide whether diagnostic blocks are appropriate based on your exam. Clinics serve Irving, Houston, San Antonio, Live Oak, McAllen and El Paso, with bilingual intake in English and Spanish. The Irving clinic is at 100 E Royal Ln, Suite 125.

Questions about payment? Call 972-920-9111 and our team will walk you through it. All services are offered in Spanish.

Call 972-920-9111 to start. If you have new weakness, loss of bladder or bowel control, or numbness in the groin, call 911.

This article is general information, not medical advice. Treatment depends on an individual clinical evaluation, and results vary.