The sudden acceleration and deceleration of the head and neck during a whiplash injury commonly damages soft tissues such as muscles, tendons, and ligaments. However, among the most frequently injured structures are the facet joints. In fact, research suggests that approximately half of neck pain cases—including those unrelated to whiplash—involve the facet joints. Why are these joints so vulnerable during whiplash?
Except for the C1 vertebra (the atlas), each cervical vertebra from C2 to C7 features paired superior and inferior facet joints that articulate with the vertebrae above and below. These joints allow for controlled movement in flexion and extension (forward/backward), lateral flexion (side bending), and—though limited—rotation. Each facet joint is richly innervated with mechanoreceptors and nociceptors (sensory fibers that detect motion and pain), making them highly sensitive to injury. Clinical studies have shown that the C2-3 and C5-6 levels are most often associated with facet joint-related neck pain.
Diagnosis of facet joint injury typically relies on clinical history and physical examination. In select cases, diagnosis can be confirmed with a diagnostic nerve block, which involves injecting a local anesthetic near the medial branch nerves that supply the affected facet joint. Diagnostic imaging like X-ray, MRI, or CT may not confirm the source of pain but can be useful for excluding other conditions or guiding interventional procedures.
Unless emergency surgery is required, treatment guidelines favor conservative care. Recommended options include neck-specific exercises, graded activity, range-of-motion training, and manual therapies such as joint mobilization and manipulation. Studies support a multimodal approach—combining several therapies—which often leads to quicker and more effective recovery. Of note, a January 2025 literature review discouraged the use of treatments such as Botox injections, intra-articular steroid injections, and surgery due to insufficient supporting evidence.
The good news is that doctors of chiropractic offer many of the conservative therapies recommended for managing facet joint injuries. In addition to relieving pain, chiropractic care helps restore normal joint motion, improving function and quality of life. If needed, your chiropractor can coordinate care with other healthcare providers to help you achieve the best possible outcome.
