Researchers do not know if impaired muscle function is the primary cause of joint dysfunction, or if the reverse is the case. A reflexogenic relationship exists between the deep myofascia and joints. Extended chronic neck pain seems to be primarily caused by facet-sticking anddegenerative joint disease.

As tension, trauma, poor posture and gravitational stress flatten the discs, the resultant hypermobility begins to pull the posterior longitudinal ligament away from the bony margins. Internal bone force fills the cracks with spurs. Along the way, osteophytes scratch the nerve dura, triggering the sinuvertebral nerve to sympathetically lead to spasm. Fortunately, these chronic-pain generators can be lessened by applying specific soft-tissue decompression maneuvers to facilitate rehydration of flattened intervertebral discs, thus relieving dural drag.

As components of the spinal anatomy begin to degrade over time ... bone loss, disc degeneration, and facet joint osteoarthritis place excess stress on theaging vertebrae. The body responds by developing bony nodules called osteophytes, or bone spurs, to compensate for diminished spinal stability. While the word "spur" often leads people to visualize something sharp or pointed digging into a nerve or other tissue, bone spurs are actually smooth and sometimes 'crusty 'growths that can be mobilized through movement.

Bone spurs are common and do not exhibit symptoms. However, when osteophytes grow inconfined areas adjacent to nerve roots or the spinal cord, nerve compression can happen. Because the uncinateprocesses are located near the foramina-- channels where nerve roots exit the spinal canal-- bone spurs that form at the uncovertebral joints maycause a condition known as foraminal stenosis (Fig 2). Should this narrowing of theforaminal canal induce nerve compression, it might produce symptoms such as localized pain, radiating pain, tingling, numbness or muscle weakness.

In the younger population, cervical radiculopathy is often a result of a disc herniation or an acute injury causing foraminal impingement of an exiting nerve. Discherniation accounts for 20-25 % of the cases of cervical radiculopathy. In our older clients, cervical radiculopathy is frequently a result of foraminal narrowing from osteophyte formation, decreased disc height, degenerative changes of the uncovertebral joints anteriorly and of the facet joints posteriorly.

What can manual and movement physical therapists do to help prevent facet jamming and nerve root impingement? I've found that in many cases, these chronic-pain generators can be lessened by applying specific soft-tissue decompression and mobilization techniques to maintain "joint play" in the facets and facilitate rehydration of flattened intervertebral discs. In the video below, I demonstrate two basic, but powerful, cervicalmobilization routines to relieve "immobilization arthritis" due to facet jamming and bone spur formation.

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