Whiplash facet syndrome can result from automobile collisions, falls, sporting injuries or any trauma to the cervical spine. Facet joint pain can be a collateral result of injury to the spine and is actually a relatively common outcome in cases of extreme cervical spinal hyperflexion and hyperextension.
Whiplash is defined as the effect that sudden acceleration or deceleration has on the neck. When a person is thrown forward or backwards by accelerative or decelerative forces, their head acts as a weight, further accentuating the motion and causing potentially massive injury to the C-spine and/or the muscular tissues of the neck. Whiplash is one of the most commonly seen forms of neck injury clinically and can sometimes enact chronic pain and spinal deterioration in the most severe instances.
This dissertation explores whiplash as a potential cause of facet joint neck pain. We will explain the mechanics of whiplash and how these forces act on the cervical spinal anatomy. We will also discuss instances where whiplash is minor, but acts as a very convincing trigger for mindbody syndromes to begin.
What is Whiplash Facet Syndrome?
Whiplash is defined as injury sustained due to sudden, acute hyperflexion and/or hyperextension of the cervical spine and surrounding musculature. It is typical that patients will suffer both hyperextension and hyperflexion from motor vehicle crashes, while falls and most other types of injuries will only involve one direction of excessive movement in the spine.
The facet joints regulate the spinal range of motion for each individual vertebral bone. In the cervical spine, the facet joints allow tremendous freedom of movement, as the neck is the most versatile region of the backbone in terms of movement ability. The cervical facet joints allow large degrees of extension and flexion, as well as moderate lateral movement and extensive amounts of vertebral rotation. When pushed past these regulated ranges of motion, the facet joints might suffer injury that can be transient or permanent, depending on many factors.
Most whiplash injuries affect the soft tissues of the neck and do not damage the spine itself. The pain might be severe, but will usually ameliorate with time and the application of conservative care practices. When the degree of traumatic force is great, then the spine itself might suffer damage, including the possibility for intervertebral herniation, ligamentous injury, facet joint trauma or vertebral fracture.
Whiplash Consequences on the Facet Joints
Focusing on the facet joints, whiplash injury can have a variety of potential consequences to both anatomical form and function:
Minor trauma might simply cause strain to the ligaments that help to stabilize and support the facet joint. Although painful, these issues usually fully resolve, although severe damage might contribute to hypermobility or hypomobility issues later in life.
Traumatic injury can damage the synovial capsule of the joint, causing it to lose fluid and suffer deterioration of the protective cartilage on the joint surfaces.
Very severe whiplash trauma can create dislocation of facet joints. Dislocation can be minor and self-correcting or might be complete, possibly necessitating surgical intervention to correct.
The worst cases of whiplash might actually fracture the affected vertebral bones at or near the facet joints. Fracture of the pars interarticularis is one of the most common facet-related locations that might require invasive care to correct.
Mindbody Whiplash Facet Syndrome
Whiplash is well known to be a trigger for mindbody disorders. Patients understand that delayed onset pain might occur and the mind might use this opportunity to create significant symptoms from ischemia, rather than from any structural injury to the spine. In essence, although the incident occurred and pain might have been suffered, no lasting damage was endured by the spine, although transient soft tissue damage is likely. However, the mind recognizes the chance for primary gain by creating chronic symptomology that will be attributed to the injury, rather than recognized of what it truly is: a reaction to a significant nocebo effect of trauma and/or a psychoemotional defense mechanism.
Further complicating this scenario is the usual discovery of facet joint degeneration upon medical imaging. Although these changes are totally normal, they are often blamed on the accident and then implicated as contributory to the current pain problem. Now the patient has “verified evidence” of structural causation and is highly unlikely to recover, despite ongoing medical intervention, including future surgery. The reason for treatment failure in these circumstances is the actual mindbody origin of symptoms that are misdiagnosed as being sourced from the injurious accident.
We see this scenario constantly and still marvel that more physicians propagate these sufferings than help to dispel them. That is, of course, until we remember the financial motivations of so many caregivers who recognize great opportunities for money-making and greedily facilitate the economic success of their practice by exploiting the suffering of naïve patients.