Quick Summary
If you have a deep, one-sided ache in your neck that worsens when you look up or turn towards the sore side, the small guiding joints at the back of your neck — the facet (zygapophyseal) joints — may be the source of your pain.
This is a common mechanical cause of neck pain, and most people improve with hands-on treatment, targeted exercise and simple changes to daily activity. Our physiotherapists in New Malden assess your neck carefully and build a programme around your specific findings.
What Is Cervical Facet Joint Pain?
Your neck has seven vertebrae, and at the back of each level a pair of small joints — the facet, or zygapophyseal, joints — link one vertebra to the next. These joints guide and limit how your neck bends, extends and rotates, sharing load with the discs at the front. Each is a true synovial joint with a capsule richly supplied by pain-sensing nerve endings, which is why it can become a genuine source of pain.
When a facet joint is injured or worn, the cartilage can thin, the capsule can become inflamed and thickened, and small bony spurs can form. Irritation of the capsule releases inflammatory chemicals that sensitise these nerve endings and produce pain. Because the joints share their nerve supply with surrounding structures, pain is often referred in recognisable patterns — the upper joints can refer towards the head, while the lower joints tend to refer to the shoulder and around the shoulder blade (Cooper et al., Pain Medicine, 2007).
Facet joints are one of the most common sources of persistent neck pain. Using controlled diagnostic nerve blocks, research has identified the facet joints as the source of pain in approximately half of people with chronic neck pain (Manchikanti et al., Pain Physician, 2020). After a whiplash injury the figure is higher still, with controlled studies reporting painful facet joints in around 54 per cent of cases (Barnsley et al., Spine, 1995). Evidence shows that a careful clinical assessment, rather than imaging alone, is the most useful way to identify whether your facet joints are contributing to your symptoms.
Do You Experience These Symptoms?
✓ A deep, aching pain usually on one side of your neck, rather than a sharp, shooting pain
✓ Pain that spreads to your shoulder, the top of your shoulder blade or between your shoulder blades
✓ Pain that is worse when you look up and when you turn or tilt your head towards the painful side
✓ Morning stiffness, or stiffness after sitting still, that eases a little as you move
✓ Tenderness when the joints at the back of your neck are pressed
✓ No true numbness, pins and needles or weakness in your arm, which helps distinguish this from a trapped nerve
✓ Sometimes a headache or pain towards the back of your head, if the upper neck joints are involved
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes Cervical Facet Joint Pain?
• Age-related degeneration
With age the facet joints can lose cartilage, develop bony spurs and become inflamed, in the same way that other joints do.
These wear-related changes are very common and are one of the main reasons facet joints become painful over time.
• Whiplash and trauma
A sudden acceleration and deceleration force, such as a road traffic collision, can strain or injure the facet joint capsule.
Research suggests facet joint pain is the most common source of persistent neck pain after whiplash, identified in around 54 per cent of cases in controlled studies.
• Sustained postures and desk work
Long periods with your head held forward or fixed — at a computer, on a phone or while driving — load the facet joints and the surrounding muscles.
This sustained loading can sensitise the joints and both trigger and maintain your pain.
• Repetitive extension and rotation
Repeatedly looking up or twisting your neck, as happens in certain jobs, trades and sports, concentrates stress on the facet joints.
Over time this repetitive loading can provoke irritation of the joint capsule and ongoing discomfort.
• Previous injury or adjacent segment loading
A past neck injury, or extra load carried by joints next to a stiff or previously fused segment, can accelerate facet joint wear.
This can make one or two levels more vulnerable to becoming symptomatic.
How We Treat Cervical Facet Joint Pain at J&J Therapy
Hands-On Manual Therapy
Hands-on treatment is a core, evidence-supported option for this type of mechanical neck pain. Our physiotherapists use graded joint mobilisation and, where appropriate and safe, manipulation of the neck and upper back, alongside soft tissue work to ease muscle guarding. Clinical practice guidelines recommend thoracic manipulation and cervical mobilisation combined with exercise for neck pain with mobility problems (Blanpied et al., JOSPT, 2017), and Cochrane evidence shows similar short-term improvements in pain and function from mobilisation and manipulation, with the strongest benefit when these are paired with exercise. We screen carefully and select the gentlest effective technique for you.
Shockwave Therapy*
Swiss Storz Medical MASTERPULS radial shockwave is not a first-line treatment for facet joint pain, and we would not use it as your main treatment. Where your assessment indicates a coexisting muscular or myofascial component that may respond, it can be offered as a non-invasive adjunct to your manual therapy and exercise programme. Evidence for shockwave in facet-related neck pain is limited, so we will always be honest about what it may and may not offer you.
Targeted Exercise Programme
Targeted exercise is a cornerstone of recovery and is well supported by the evidence. Our physiotherapists typically progress you through deep neck flexor training to restore support and control, scapulothoracic and shoulder girdle strengthening, and neck mobility and postural work, alongside a graded return to your normal activities. Cochrane evidence shows that cervico-scapulothoracic and upper limb strengthening reduces pain and improves function in persistent neck pain (Gross et al., Cochrane, 2015), and guidelines recommend combining exercise with manual therapy. We tailor your programme to your findings and teach you a manageable home routine to do little and often.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
Neck pain following significant trauma, such as a high-impact fall or a road traffic collision
Progressive weakness, numbness or clumsiness in your arms or hands, or new problems with balance or walking
Fever, unexplained weight loss or feeling generally unwell alongside your neck pain
Severe, constant pain that does not ease with rest or a change of position and wakes you at night
FAQs About Cervical Facet Joint Pain
How is facet joint pain different from a trapped nerve or disc problem?
Facet joint pain is usually a deep, one-sided neck ache that may spread to your shoulder or shoulder blade, and it is typically worse when you look up or turn towards the sore side.
A trapped nerve more often causes arm pain with numbness, pins and needles or weakness following the path of the nerve. Our assessment helps tell these apart, which guides the right treatment for you.
How long does it take to improve?
This varies from person to person. Most cases of acute neck pain settle within around two months, although some people continue to experience low-grade symptoms or recurrences for longer.
Longstanding or whiplash-related facet pain can take more time, and research suggests that combining manual therapy, targeted exercise and staying active gives the best chance of improvement.
Do I need a scan or an X-ray?
Usually not. Imaging often cannot confirm a facet joint as the source of pain, because wear-related changes appear on scans in people both with and without neck pain.
Scans are mainly used when there are warning signs or nerve-related symptoms. Otherwise the working diagnosis is made from your history and a physical assessment.
Can facet joint pain cause headaches?
Yes, it can. When the upper neck joints are involved, pain is often referred to the back of your head and can be experienced as a headache.
Treatment directed at the upper neck may help ease these symptoms.
Would shockwave therapy help my facet joint pain?
Shockwave is not a first-line or established treatment for facet joint pain itself, and we would not use it as your main treatment.
If your assessment indicates a coexisting muscular or trigger point component that may respond, radial shockwave may be offered as an adjunct to your manual therapy and exercise. We will always explain what the evidence does and does not show before recommending it.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
Last reviewed:
2026년 8월 20일