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As mobility in the neck declines the facet joint capsules, the fibrous bags which surround the joints, are vulnerable to overstretching trauma. An unplanned movement such as turning without thinking about it can pull against the limits of the tightened capsules and cause trauma to the capsular fibres. The pain causes movement inhibition and as the capsules heal up with scar tissue they can tighten further and thereby tolerate further stretching even less. This process can spread to several areas of the neck, causing significant unnoticed restriction in range of movement until one day you suddenly realise that you cant turn as far as you need to.

The pain sources from facet joint arthropathy are due to various reasons: the local musculature responds to pain by developing muscle spasm; the local facet joint is suffering from pathological changes and there is referred pain. Localised neck pain, the centre of which is often identifiable by feeling with the fingers, comes from the irritated facet itself while the referred pain is much less clear in nature, expressing itself as a vaguer general feeling of ache in the arm or shoulder. As the neck problems increase it can interfere with important abilities such as sleeping which can lead to side effects such as depression and anxiety.

Turning the neck suddenly, being jarred unexpectedly or towelling the hair vigorously can result in a sudden onset of severe neck pain and loss of movement, a condition referred to as acute wry neck. People can also awake with the same kind of problem, perhaps because they have slept awkwardly and strained the neck. The facet joint locks instantly as the speed and unexpectedness of the activity bypasses our control and stability mechanisms. The sensitive capsular joint surround might be strained in these events or the joint could pinch a synovial membrane fold, resulting in instant, severe pain in the neck and limiting muscle spasm.

An acute wry neck is an unpleasant experience with acute pain on one side of the neck and a loss of neck movement. There may be very strong muscle spasm holding the neck in an odd posture to one side. Careful guarding of movements and avoidance of jarring or sudden motions is evident to avoid any sudden movement which might increase the muscular spasm and the forces of neck compression. It can be a challenge merely to get into and out of, with holding of the head typically needed as the movement down or up is performed to minimise muscle activity in the neck.

Early manipulation of a locked cervical facet joint by a chiropractor, osteopath or manipulative physiotherapist can release the joint, perhaps by gapping the joint surfaces, releasing the trapped membrane or by allowing the joint to realign. Typically the recovery period takes longer, with a few days of painkillers and anti-inflammatories needed before the pain begins to settle down and movement starts to return. Joint mobilisations, a less forceful technique than manipulation, are very useful to ensure the joint does not harbour any long-lasting movement abnormalities which could predispose to recurrence or perpetuation of neck pain.

A facet joint lock episode is not the only possible reason for the sudden or a slower onset of neck pain as this can also be caused by a prolapsed disc or inflammatory insult to the nerve. If an original locking injury to the facet joint does not recover well or completely then the nerve root exiting through the narrow foramen can be surrounded by an inflammatory fluid which can gradually thicken into fibrous tissue. This can tether the nerve and if the nerve then suffers a quick stretch, which nerves are especially bad at tolerating, it can set up a very unpleasant syndrome with severe arm, shoulder and neck pain.

Although neck pain may not be the major presenting part of the problem, patients often indicate there were some warning signs from their neck previously, with the neck or arm being less predictable and reliable on various activities. The precipitating reason for the full syndrome may be something small, just in the right direction to stress the nerve.