Why Neck Pain Keeps Coming Back: Facet Joint Pain After Whiplash

By: Brad Gorski, DC, FSBT | Elite Family Chiropractic | Charleston, SC

Why does your neck pain keep coming back after a car accident?

Maybe you were involved in a collision several months ago. Your neck pain improved with treatment, but every time you return to certain activities, the same discomfort returns.

Or perhaps you've already been diagnosed with facet joint pain. You've had injections, a medial branch block, or even radiofrequency ablation, but you're still trying to understand why the pain hasn't completely gone away.

These are two different patient experiences, but they often lead to the same question:

What's actually causing my neck pain, and why does it keep returning?

When most people think about spinal injuries, they think about herniated discs, pinched nerves, or pulled muscles. But there's another important structure that doesn't receive nearly as much attention: the facet joint.

These small joints help your spine move while contributing to its stability. They can also be a significant source of pain following a whiplash injury.

In my practice, understanding these joints—and the ligaments surrounding them—is an important part of evaluating patients with persistent neck pain.

Because treating pain and understanding the underlying injury are not always the same thing.

What Is a Facet Joint, and Why Can It Cause Neck Pain?

Your spine is made up of individual bones called vertebrae. Between most neighboring vertebrae are spinal discs toward the front and two small joints toward the back called facet joints.

The facet joints help guide movement as you turn your head, look up, look down, or bend to the side.

They're also synovial joints, similar in basic design to the joints in your fingers, knees, and shoulders. They contain cartilage, joint fluid, and a surrounding capsule.

When I'm explaining facet joints to patients, I often pick up a model of the spine and demonstrate how these joints move. I show them what happens when the neck bends forward, extends backward, or rotates.

Then I point out a structure most people have never heard of: the facet joint capsule.

What Is the Facet Joint Capsule?

Think of the capsule somewhat like a strong, flexible piece of plastic wrap surrounding a joint.

It's not a perfect comparison, but it helps patients visualize how this structure encloses the joint while allowing movement.

The facet capsule contains ligamentous connective tissue that helps guide and limit movement between neighboring vertebrae.

Your neck needs enough flexibility to turn comfortably while driving, but it also needs stability so the individual bones don't move excessively.

The facet joint capsule is part of the system that provides both.

Here's something particularly important: the capsule contains sensory nerve endings involved in pain signaling and joint-position awareness.

Research by McLain identified mechanoreceptors and pain-sensitive nerve endings within human cervical facet joint capsules.[1]

That means the capsule isn't simply a passive covering around the joint. It participates in the sensory information your nervous system uses to help coordinate spinal movement.

And when the joint or surrounding tissues become irritated or injured, they may contribute to pain.

How Can Whiplash Injure the Facet Joints?

Whiplash describes a rapid acceleration-deceleration movement of the head and neck.

It's commonly associated with car accidents, particularly rear-end collisions, but can also occur during falls, sports injuries, and other sudden impacts.

Your neck is designed for coordinated movement. During an unexpected collision, however, the forces applied to the head and neck can create unusual movement between individual vertebrae.

Research by Grauer and colleagues demonstrated that during simulated rear-end collisions, the cervical spine could briefly form an S-shaped configuration.[2]

The lower portion of the neck moved into extension while the upper neck remained in relative flexion.

This occurs rapidly and under loading conditions very different from ordinary neck movement.

Muscles can begin responding during the collision, but those responses may not be sufficient to prevent excessive loading of the joints and surrounding ligaments.

Additional biomechanical research by Stemper and colleagues demonstrated increased cervical facet joint motion under whiplash-type loading compared with normal physiological movement.[3]

These findings help explain how the facet joints and their supporting capsules may experience excessive forces during certain collisions.

But here's an important distinction.

A facet joint injury does not necessarily mean the joint is broken or that the capsule has completely ruptured.

The severity of the injury matters, and determining which tissues may be involved is an important part of developing the appropriate treatment plan.

For more on how collisions can affect spinal ligaments, see Low-Speed Crash, Real Injuries: How Ligaments Get Hurt.

Facet Joint Capsule Injuries: Understanding Ligament Sprains Versus Muscle Strains

One distinction I frequently explain to patients is the difference between a strain and a sprain.

These terms are often used together, particularly after a car accident, but they describe injuries to different tissues.

A strain involves a muscle or tendon. Tendons connect muscles to bones.

A sprain involves a ligament. Ligaments connect bones and help stabilize joints.

Since the facet joint capsule contains ligamentous tissue, an injury to that ligamentous structure is classified as a sprain.

This distinction matters because muscles and ligaments have different functions and can have different healing characteristics.

What Are the Three Grades of a Ligament Sprain?

Ligament sprains are generally classified by severity:

Grade 1 — Mild Ligament Sprain

A Grade 1 sprain involves mild overstretching and damage to a small number of ligament fibers. The joint generally maintains its mechanical stability, although pain and localized tenderness may occur.

Grade 2 — Moderate Ligament Sprain

A Grade 2 sprain involves partial tearing of the ligament. Depending on the extent and location of the injury, some joint laxity or abnormal movement may develop.

Grade 3 — Severe Ligament Sprain

A Grade 3 sprain involves complete ligament rupture. This can significantly compromise joint stability and may require specialized medical evaluation and, in selected cases, surgical management.

These classifications describe the severity of ligament injury. However, grading a cervical facet capsule injury in an individual patient can be challenging, and symptoms or motion measurements alone cannot reliably establish the grade.

Do Injured Ligaments Heal the Same Way Muscles Do?

Not necessarily. Ligaments have a highly organized collagen structure that helps them resist and control mechanical forces.

When a ligament is injured, the body begins a repair process involving inflammation, collagen production, and tissue remodeling.

Research by Tozer and Duprez examined the development, structure, and repair of tendons and ligaments, highlighting the complexity of these connective tissues.[4]

Additional research by Frank describes how ligament healing often involves the formation of scar tissue with biological and mechanical properties different from those of the original ligament.[5]

This is an important distinction between tissue repair and complete restoration of the original tissue structure.

A ligament may become functional again without returning to precisely its pre-injury microscopic organization.

With more significant injuries, residual laxity or altered mechanical properties may persist.

However, scar formation does not automatically mean permanent instability, chronic pain, or lifelong disability. Many people regain excellent function following ligament injuries.

The severity of the injury, the surrounding tissues, rehabilitation, and the patient's functional recovery all matter. This is why identifying the injured tissue is important.

We're not simply asking whether someone has neck pain. We're trying to determine what may have been injured, how that injury affects function, and what the patient needs to recover.

What Does Cervical Facet Joint Pain Actually Feel Like?

One of the first things I look for is the pattern of a patient's pain.

A common presentation that raises my suspicion of cervical facet involvement is recurring neck pain that travels into the upper trapezius, across the top of the shoulder, or toward the shoulder blade.

Patients often describe a deep, aching discomfort. Some notice that particular movements reproduce the pain. Turning the head, looking upward, or remaining in one position for extended periods may aggravate symptoms.

Sometimes changing positions provides relief, but the discomfort returns later. This can be an example of referred pain.

Referred pain means a painful structure can produce discomfort somewhere other than its immediate anatomical location.

Facet Joint Pain Versus a Pinched Nerve

This distinction is particularly important during a spine examination.

Facet-related pain may produce aching discomfort around the neck, upper shoulder, or shoulder blade.

Pain involving a cervical nerve root may travel farther down the arm and can be accompanied by numbness, tingling, burning, or weakness.

For example, someone experiencing recurring pain across the upper trapezius may have a different problem than someone whose neck pain is accompanied by tingling into the thumb.

However, these patterns can overlap.

A patient can also have both facet joint involvement and nerve-root irritation.

That's why we don't diagnose facet pain based only on where someone hurts.

We consider the symptoms, examination findings, neurological function, movements that reproduce pain, and other relevant diagnostic information.

For more on the differences, see Pinched Nerve in Neck: Treatment Options.

Can Facet Joints Cause Chronic Neck Pain Without a Car Accident?

Absolutely.

Although this article focuses on whiplash injuries, facet joint pain is not limited to people who have experienced trauma.

The cervical facet joints may contribute to chronic neck pain related to joint degeneration, osteoarthritis, inflammatory conditions, or other mechanical problems.

Some patients develop symptoms gradually without remembering any particular injury.

Others experience recurring discomfort associated with certain movements or activities.

It's important to understand that facet joint pain can develop through different mechanisms.

A patient who develops neck pain over several years may not have the same underlying condition as someone who experiences sudden neck pain following a collision. And those differences can influence treatment.

The diagnosis should guide the treatment—not simply the location of the pain.

Can Lumbar Facet Joints Become Injured or Cause Lower Back Pain?

Yes. Facet joints are found throughout the cervical, thoracic, and lumbar spine.

The lumbar facet joints help guide movement and distribute forces through the lower back. Like the cervical facet joints, they have capsules containing ligamentous tissue.

These structures may experience injury during trauma, but they can also become sources of chronic low back pain associated with degeneration or other conditions.

In my practice, a patient with suspected lumbar facet-related pain may describe discomfort across the lower back that travels into the buttock or upper thigh.

That can differ from a typical lumbar nerve-root pattern, where pain, numbness, or tingling may travel farther down the leg.

However, pain patterns frequently overlap, and neither distribution establishes the diagnosis by itself.

Lumbar facet pain is also an established topic in interventional spine medicine, with published consensus guidelines addressing its diagnosis and management.[10]

A 2023 biomechanical study by Middendorf and colleagues further demonstrated that the lumbar facet capsular ligament can undergo changes in stiffness and directional mechanical behavior associated with disc and facet degeneration.[8]

The study examined degeneration rather than acute traumatic injury, but it reinforces the importance of understanding the facet joint as a mechanical structure.

For patients dealing with ongoing lumbar symptoms, I've also explained how different tissues can contribute to lower back pain after a car accident.

Whether we're evaluating the cervical or lumbar spine, the objective is the same: identify the structures that may be contributing to symptoms and determine what kind of treatment or management is appropriate.

Why Does Facet Joint Pain Sometimes Keep Coming Back?

This may be the most important question in the entire discussion. Imagine someone who develops neck pain following a motor vehicle collision.

They begin conservative treatment and improve. They can turn their head more comfortably, their pain decreases, and they start getting back to normal activities.

But several weeks later, the pain returns. Maybe the upper trapezius begins aching again. Maybe turning the neck becomes uncomfortable, or sitting at a computer causes symptoms to build throughout the day.

The patient returns for treatment, feels better, and then experiences the same problem again.

Why does that happen?

The answer isn't always simple. Sometimes the joint remains irritated. Sometimes surrounding muscles don't yet have the strength, endurance, or coordination needed to tolerate normal activities.

Other patients may have an associated disc injury, nerve irritation, or another source of pain.

And in selected cases, injury involving the facet capsule or surrounding ligaments may have affected the mechanics of that spinal segment.

It's also important to recognize that persistent pain can involve changes in the nervous system's sensitivity, even after the original tissue injury has improved.

This is why I don't automatically assume that returning pain means ongoing ligament damage or spinal instability. Instead, I want to know why the patient isn't progressing as expected.

Is the original diagnosis correct? Are we treating the appropriate structure? Is rehabilitation addressing the patient's functional needs? Is there another condition we haven't fully evaluated?

Those questions should guide what happens next.

Persistent muscle tightness can sometimes reflect protective guarding around painful spinal structures. I've discussed that relationship in Why Is My Neck So Stiff After a Car Accident? The Role of Ligament Injury.

How Do We Determine Whether the Facet Joint Is Causing Pain?

This is where a thorough examination becomes important. In my office, I start by considering the entire patient history.

What happened during the injury? When did symptoms begin? Where does the pain travel? What movements reproduce it? Has the patient improved with previous treatment, or do the symptoms keep returning?

I also want to know what treatments have already been performed.

During the examination, I assess cervical movement, neurological function, tenderness, and how the patient responds to specific movements.

I'll often palpate around the facet joints to see whether pressure over a particular region reproduces the patient's familiar pain.

That information can help guide the examination, but tenderness alone cannot confirm which joint or tissue is responsible.

When Are X-rays, MRI, or Motion Analysis Helpful?

Depending on the examination findings, imaging may help clarify what we're dealing with.

X-rays can provide information about spinal alignment, bone changes, and certain structural abnormalities.

MRI can help evaluate discs, nerve roots, the spinal cord, and some soft-tissue injuries.

An important part of the evaluation may be determining whether symptoms suspected to originate from a facet joint could actually involve a disc or nearby nerve.

This is why understanding the difference between a disc bulge and a herniated disc can be useful.

However, imaging also has limitations.

An MRI doesn't consistently identify every facet capsule injury, and an abnormality on imaging doesn't automatically prove that structure is generating pain.

My fellowship training in spinal biomechanics and trauma also informs how I evaluate movement between individual vertebrae. For selected patients, quantitative cervical motion analysis may provide additional measurements of how individual spinal segments move relative to one another.

Depending on the analysis, these measurements can include angular motion, translation, and the center of rotation between neighboring vertebrae.

They may help identify areas that warrant closer investigation when the examination suggests a mechanical problem.

But it's important to understand that abnormal motion measurements don't independently prove a torn capsule, establish the grade of a sprain, or determine exactly when an injury occurred.

These findings must be interpreted within the total clinical picture. Motion testing is not appropriate for every patient, particularly when a potentially unstable acute injury has not yet been ruled out.

I've explained this process in greater detail in How Motion Analysis May Help Explain Neck Pain After a Car Accident.

What About Diagnostic Facet Joint Blocks?

In selected patients, a pain management physician may use diagnostic or prognostic medial branch blocks to evaluate whether the facet joints are a likely source of pain.

These injections temporarily interrupt pain signals from nerves supplying the joints.

The patient's response can provide useful information about whether facet-mediated pain is likely and whether certain procedures may be appropriate.

But even a positive block doesn't prove that the joint capsule is torn or identify the precise tissue pathology.

Likewise, imaging findings alone may not establish that a facet joint is painful.

This is one reason understanding the role of each diagnostic tool is important.

The goal isn't to order every test available. It's to use the information that can meaningfully improve the diagnosis or treatment plan.

What If My MRI Shows Facet Arthritis?

One thing I frequently explain to patients is that arthritis does not automatically equal pain.

Degenerative changes in the facet joints are common, particularly as people get older.

Some patients have significant arthritis on imaging and experience little or no pain.

Other patients have relatively modest imaging findings but substantial discomfort and functional limitations.

That's why we don't treat an MRI report by itself.

We need to determine whether the findings actually correlate with the symptoms, examination, and overall clinical presentation.

Degenerative changes and an acute injury can also exist together.

Researchers use grading systems to describe the severity of disc and facet degeneration, but those grades cannot independently establish exactly when a traumatic injury occurred or which changes are responsible for pain.

A thoughtful clinical assessment looks at the totality of the case rather than relying on one finding.

If you've been told your pain is simply caused by arthritis, I recommend reading I Have Arthritis in My Spine — Is That Actually What's Causing My Pain?.

What Does Research Tell Us About Facet Joint Injuries and Recovery?

Research provides important insight into why facet joints deserve attention following whiplash.

In a placebo-controlled study, Lord and colleagues identified cervical facet joints as a source of persistent neck pain in a substantial proportion of a selected group of patients with chronic symptoms following whiplash.[6]

That finding helped establish the clinical importance of these joints in patients with persistent post-whiplash pain.

A 2021 systematic review by Malik and colleagues examined the relationship between preexisting cervical degeneration and recovery following whiplash-associated disorders.[7]

The authors found moderate evidence linking preexisting facet joint degeneration to poorer recovery.

They also proposed that facet joint capsule rupture and resulting instability could be one possible mechanism contributing to non-recovery.

This is an important proposed mechanism, not proof that every patient with persistent pain has a ruptured or unstable facet joint.

Additional research has examined how facet capsule tissue properties change with degeneration.

In the 2023 study discussed earlier, Middendorf and colleagues found that lumbar facet capsular ligaments demonstrated changes in stiffness and directional mechanical behavior associated with disc and facet degeneration.[8]

Although that study examined lumbar degeneration rather than cervical whiplash, it helps illustrate how changes in the supporting tissues may influence joint biomechanics.

Together, these studies reinforce a point I believe is important for both patients and healthcare providers.

Facet joints are not simply small joints that occasionally develop arthritis. They're part of a complex system that helps control spinal movement, and they can be important sources of pain.

That doesn't mean every facet injury becomes chronic or that every patient requires advanced treatment.

It means these structures deserve appropriate evaluation and management.

I've Already Had Facet Injections or Ablation. Why Am I Still Hurting?

This is another important part of the patient journey. Some people arrive at my office after they've already undergone medical treatment for facet joint pain.

They may have received a facet joint injection, medial branch block, or radiofrequency ablation. Sometimes those procedures provide substantial relief. Other times, the improvement is temporary, incomplete, or doesn't occur.

To understand why, it helps to understand what each procedure is designed to accomplish.

Facet Joint Injections

These procedures may deliver medication directly into a facet joint, sometimes including a corticosteroid intended to reduce inflammation and pain.

Their usefulness depends on the patient's diagnosis and circumstances, and they are not recommended routinely for every patient with suspected facet pain.

Medial Branch Blocks

These use local anesthetic to temporarily interrupt pain signals carried by small nerves supplying the facet joints.

Their primary purpose is often to help determine whether facet-mediated pain is likely and whether radiofrequency treatment may be beneficial.

Radiofrequency Ablation

Radiofrequency ablation uses heat to interrupt selected pain-transmitting nerves.

For appropriately selected patients, it may provide longer-lasting relief than a diagnostic block.

These procedures have an established role in interventional spine care, with clinical guidelines discussing their use, limitations, and patient selection.[9]

But here's the distinction I want patients to understand: Treating pain is different from directly treating damaged tissue or an underlying mechanical problem.

A pain management physician may successfully reduce the pain coming from a facet joint without directly repairing an injured capsule or changing how that spinal segment moves.

That doesn't mean the treatment was wrong. In fact, reducing pain can sometimes create an important opportunity for someone to participate more effectively in rehabilitation.

But if the pain returns, we need to understand why. A medial branch block is temporary by design.

Pain can return after radiofrequency ablation as nerves recover, or because other pain-generating structures and mechanisms remain involved.

And in some patients, there may still be underlying joint pathology, muscle weakness, impaired movement control, or another mechanical problem that needs attention. Pain returning after a procedure does not automatically prove the ligament is damaged or the joint is unstable.

The next step may be rehabilitation, reassessment of the diagnosis, additional testing, or another treatment approach.

This is why I believe pain management and conservative spine care can complement each other.

The objective is not to criticize a procedure that helped. It's to understand what that procedure accomplished and what the patient may still need.

I've explained this collaborative approach in Whiplash Treatment: How Chiropractic and Pain Management Can Work Together.

Does Every Facet Joint Injury Require Injections or Medical Intervention?

No. And I think that's important for patients to hear. Many people seek conservative care because they would prefer to avoid medication, injections, or surgery when possible.

For patients who have been appropriately evaluated and have no findings requiring urgent medical intervention, a conservative treatment plan may be a reasonable starting point.

Depending on the diagnosis, care may include chiropractic treatment, gentle joint mobilization, soft-tissue therapies, therapeutic exercise, and progressive strengthening.

The goal is to improve comfortable movement, manage pain, and rebuild the strength and control needed for everyday activity.

If there is concern for significant ligament injury or spinal instability, treatment must be modified appropriately.

Increasing movement through a potentially unstable segment is not the objective. Some patients recover quickly and never need injections or other procedures.

Others may benefit from physical therapy, additional imaging, or evaluation with a pain management physician.

When clinically appropriate, conservative care may begin while additional imaging or referral is being arranged.

However, suspected serious instability, progressive neurological deficits, or other warning signs require timely medical assessment before routine treatment proceeds.

The important thing is recognizing that not every patient needs the same treatment or the same team of healthcare providers.

And when someone isn't improving as expected, the answer shouldn't automatically be more of the same treatment.

The diagnosis and treatment plan need to be reassessed.

Can Facet Joint Injuries Heal, or Will I Always Have Neck Pain?

Many patients with facet-related pain improve and return to their normal activities.

Some injuries resolve with conservative care and rehabilitation. Others may take longer, particularly when there are additional structural changes, significant ligament damage, or multiple sources of pain.

And some patients experience persistent or recurring symptoms. One of the principles I've come to appreciate in spine care is that not every injury follows the same recovery pattern.

A simple muscle strain may resolve completely. A more significant injury involving a spinal joint, disc, or supporting ligament may require a different approach, sometimes including ongoing management.

But that doesn't mean someone needs chiropractic adjustments, injections, or medical procedures forever.

Ongoing management might mean continued strengthening, periodic reassessment, adjustments to certain activities, or additional care when clinically necessary.

For some patients, management eventually becomes largely independent. Others may benefit from occasional support from physical therapy, pain management, or another healthcare provider.

The need for ongoing management does not automatically mean lifelong treatment.

It's also important to distinguish tissue recovery from functional recovery.

A ligament that has undergone scar-mediated repair may not have precisely the same microscopic structure it did before the injury.

But that doesn't mean the patient cannot regain meaningful strength, stability, mobility, and quality of life. I've seen patients with significant spinal injuries return to work, exercise, recreation, and the activities they enjoy with their families.

That's why recovery shouldn't be measured only by whether a patient reports zero pain. It should also be measured by what they can do and how well they're living.

If you'd like to explore this question further, I've also written about whether facet joint pain goes away.

Why Proper Spine Management Matters

When someone is dealing with recurring neck pain, the most important question isn't necessarily which treatment will reduce their pain the fastest.

The bigger question is: What is contributing to the problem, and what does this patient need to recover or function better?

Sometimes the answer is conservative chiropractic care. Sometimes it's a structured rehabilitation program with a physical therapist.

Other patients may benefit from pain management, additional diagnostic testing, or a surgical evaluation.

And sometimes, once the patient understands their condition and has regained function, no further professional treatment is needed.

At Elite Family Chiropractic in Charleston, my fellowship training in spinal biomechanics and trauma helps inform how I evaluate spinal injuries, interpret relevant diagnostic information, and coordinate care when appropriate.

I believe effective spine management requires understanding the condition, monitoring the patient's progress, and being willing to change the plan when the clinical findings call for it.

Not every patient needs multiple providers, but those who do should have a clear understanding of why each clinician is involved. The goal is not to make every spinal problem fit one particular treatment.

It's to help patients receive the care they need, from the appropriate providers, at the appropriate time.

Final Thoughts: Your Neck Pain Deserves More Than a Temporary Solution

If your neck pain keeps returning after whiplash, that doesn't automatically mean you have a serious ligament injury or that your condition will become permanent.

But it does mean recurring symptoms deserve to be understood. The facet joints and their surrounding capsules may be one part of that explanation.

A careful evaluation can help determine whether your symptoms are related to these joints, another spinal structure, or a combination of factors.

Some patients need only a short course of conservative care. Others require a more involved recovery or management plan.

Whatever the diagnosis, the objective remains the same. We want to help you understand your condition, improve your function, and get back to the things that make your life yours.

If you're experiencing persistent neck pain after a collision, Elite Family Chiropractic's car accident injury evaluation can help determine the appropriate next step.

Frequently Asked Questions About Facet Joint Pain

Can whiplash cause facet joint pain?

Yes. Research supports the cervical facet joints as a potential source of neck pain following whiplash. Sudden acceleration-deceleration forces can place excessive loads on the joints and supporting tissues. However, symptoms alone cannot confirm a specific facet joint or capsule injury.

What does facet joint pain feel like in the neck?

Cervical facet pain may produce a deep ache in the neck that travels into the upper trapezius, shoulder, or shoulder blade. Certain neck movements may increase discomfort. Other conditions can cause similar symptoms, making clinical evaluation important.

What is the difference between a facet capsule sprain and a muscle strain?

A sprain involves ligamentous tissue, while a strain involves a muscle or tendon. Because the facet capsule contains ligamentous connective tissue, an injury to those fibers is classified as a sprain. Significant ligament injuries may affect joint stability and require a different management approach than a muscle strain.

Can facet joints cause chronic neck pain without an accident?

Yes. Facet joint pain can occur without a traumatic injury. Joint degeneration, arthritis, and other conditions can contribute to chronic neck pain. However, degenerative findings on imaging do not automatically establish the facet joint as the source of symptoms.

Can lumbar facet joints become injured?

Yes. The lumbar facet joints and their surrounding capsules can be injured by excessive loading or trauma. They may also contribute to chronic lower back pain associated with degeneration or other conditions. Lumbar facet-related pain may extend into the buttock or upper thigh.

Can an MRI detect a torn facet joint capsule?

MRI may identify some ligament and soft-tissue abnormalities, but it cannot consistently detect every facet capsule injury. Imaging findings must be interpreted alongside the patient's symptoms, examination, and other relevant diagnostic information.

Why does neck pain return after a medial branch block or ablation?

A medial branch block temporarily interrupts pain signals, while radiofrequency ablation may provide longer-lasting relief. Symptoms can return as nerves recover, or because additional pain generators or functional problems remain. Returning pain does not automatically indicate ligament damage or instability.

Do all facet joint injuries require injections?

No. Many patients improve with appropriate conservative care, exercise, and rehabilitation. Injections or other medical procedures may be considered when symptoms, examination findings, and response to previous treatment justify them.

Can a facet joint capsule injury become chronic?

Some patients experience persistent or recurring symptoms following significant spinal injuries, including possible ligamentous injuries. Others recover successfully. Even when ongoing management is necessary, patients may still make substantial improvements in function, pain, and quality of life.

Research References

1. McLain RF. Mechanoreceptor endings in human cervical facet joints. Spine. 1994;19(5):495–501.

2. Grauer JN, Panjabi MM, Cholewicki J, Nibu K, Dvorak J. Whiplash produces an S-shaped curvature of the neck with hyperextension at lower levels. Spine. 1997;22(21):2489–2494.

3. Stemper BD, Yoganandan N, Gennarelli TA, Pintar FA. Localized cervical facet joint kinematics under physiological and whiplash loading. Journal of Neurosurgery: Spine. 2005;3(6):471–476.

4. Tozer S, Duprez D. Tendon and ligament: Development, repair and disease. Birth Defects Research Part C: Embryo Today: Reviews. 2005;75(3):226–236.

5. Frank CB. Ligament structure, physiology and function. Journal of Musculoskeletal and Neuronal Interactions. 2004;4(2):199–201.

6. Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash: A placebo-controlled prevalence study. Spine. 1996;21(15):1737–1744.

7. Malik K, Eseonu KC, Pang D, Fakouri B, Panchmatia JR. Is Preexisting Cervical Degeneration a Risk Factor for Poor Prognosis in Whiplash-Associated Disorder?. International Journal of Spine Surgery. 2021;15(4):710–717.

8. Middendorf JM, Budrow CJ, Ellingson AM, Barocas VH. The Lumbar Facet Capsular Ligament Becomes More Anisotropic and the Fibers Become Stiffer With Intervertebral Disc and Facet Joint Degeneration. Journal of Biomechanical Engineering. 2023;145(5):051004.

9. Hurley RW, et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Regional Anesthesia & Pain Medicine. 2022;47(1):3–59.

10. Cohen SP, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Regional Anesthesia & Pain Medicine. 2020;45(6):424–467.

Author

Brad Gorski DC, FSBT At Elite Family Chiropractic in Charleston, South Carolina, Dr. Brad Gorski is a top-ranked chiropractor offering effective treatment options for back pain, knee pain, neck and shoulder pain, sciatica, migraines, pinched nerves, herniated discs, and more. Dr. Gorski received his Doctor of Chiropractic degree from Palmer College of Chiropractic in Davenport, Iowa in 2008. He has completed extensive post-graduate training, becoming qualified in Hospital Based Spine Care, MRI Interpretation Review, and Trauma while also completing a Fellowship in Spinal Biomechanics and Trauma. He provides chiropractic care and helps his patients achieve their goal of optimum health and wellness.