Joint Entrapment in the Spine

If you can answer "yes" to any of the questions below, scroll down and read Dr. Pardee's booklet Joint Entrapment in the Spine.

1. You woke up with neck pain. You can't turn your head in one direction. You can easily turn it the other direction.

2. You have a frozen neck. You can hardly move it in any direction. You don't remember doing anything to cause it. You probably woke up with it.

3. You have a pain between your shoulder blades on one side of the spine that feels like you have an ice pick in your back. It probably started from reaching for something.

4. You have very painful low back pain at about the waist level on one side of the spine that happened for no good reason by just bending over.

Joint Entrapment in the Spine

“The Velcro Effect”

by Stuart Pardee D.C.

These pages describe a condition that in my many years of experience is the number one cause of acutely painful, non-traumatic, spinal related pain seen in my office. By a huge margin.

Within the spine are many small joints called synovial joints. These joints are all surrounded by what is called a joint capsule. (Think of the joint capsule as the rubber boot that surrounds a U-joint in a car). Within the joint capsule is a fluid called synovial fluid. This fluid lubricates the joint.

Joint entrapment occurs within the joint capsule of the synovial joints of the spine. It commonly occurs in four different areas. Each area has its own distinct mechanism of occurrence, and very distinct symptoms, which I describe in these pages.

Normally the synovial joints of the spine, lubricated with synovial fluid, move very smoothly. The synovial joints have the characteristic that they will suddenly, and for no apparent reason, stick (or lock, as some research papers describe it). They can do it very suddenly, and when it happens the joint is excruciatingly painful. I call this “The Velcro Effect”.

The most common areas that joint entrapment occurs in the spine are the atlanto-occipital joints (the two joints where the head sits on the neck), the atlanto-axial joint (the two joints immediately below the atlanto-occipital joints), the costo-vertebral (and costo-transverse) joints (the joints where the ribs join the spine), and the lumbar facet joints (the small joints in the low back). I describe each of these in this booklet.

The Atlanto-Occipital Joint

The bottom of the head is called the occiput. The top vertebra in the neck is called the atlas, also called C1. The two small joints at the bottom of the head where the head and neck join are called the atlanto-occipital joints, often abbreviated the “A-O” joints.

Entrapment of either atlanto-occipital joint can occur both traumatically and nontraumatically. Traumatically, any sudden impact or force that causes a shearing or twisting of the atlanto-occipital joint can cause it. Auto “whiplash” injuries, or falls where someone lands on their head, are examples of this.

Non-traumatically, it occurs two ways. One is holding the head and neck in an extended position for a long period of time. I see this commonly in people who are painting ceilings or wallpapering. I've seen it a few times in people who attended an air show and looked up at the airplanes all day. The second way it occurs is having the head and neck bent sideways for an extended period of time. I commonly see this with people who fall asleep on a couch watching TV. They are lying on their side with their head kinked sideways.

The classic symptom of non-traumatic induced entrapment at the atlanto-occipital joint is a frozen neck. The person can't move their head in any direction. Usually their head will be slightly bent forward. It is almost impossible for them to extend their neck backwards. The majority of the pain is not felt in the neck. It is felt in the spinal cord right below the neck, and is always centrally located. The pain can extend down to between the shoulder blades, and can spread sideways toward the shoulders and shoulder blades. It can be very frightening for the person.

There are many other symptoms caused by entrapment at the atlanto-occipital joint, the most common being headaches, but the frozen neck is the classic symptom when it occurs non-traumatically.

Chiropractors call this an atlas subluxation. For a more detailed explanation of the atlas subluxation, please read my other pamphlet “The Atlas Subluxation”.

The Atlanto-Axial Joint

The atlas is the top vertebra in the neck. The axis is the vertebra right below it, also called C2. The joint where these two vertebrae join is called the atlanto-axial joint, or the C1/C2 joint. When you rotate your head, most of the movement occurs at this joint.

Entrapment of the atlanto-axial joint seldom occurs from trauma. People usually just wake up with it, although I have seen it occur when someone turns their head too fast.

The symptom is always the same. The pain is on one side of the neck, concentrated near the base of the skull. The person's head will be bent sideways and slightly rotated away from the side of pain. They can easily turn their head away from the side of pain, but they can't turn into the pain. The C1/C2 joint is exquisitely tender to palpation on the side of pain. The pain travels down the affected side of the neck and radiates toward the shoulder. Chiropractors call this an axis subluxation.

The Costo-Vertebral Joints

The costo-vertebral joints are the joints where the ribs join the spine. Joint entrapment occurs in these joints. The most common levels are between the shoulder blades, although I have seen it occur at every level in the thoracic spine.

It is very painful. The person will describe it as an ice pick or knife in their back. It is always on one side of the spine.

I seldom see it occur from trauma. It almost always occurs from reaching for something.

It is very easy to diagnose. You can put your finger right on the pain, which is about a half inch to an inch to the side of the spine, right where the rib joins the spine. The spot will be exquisitely painful. Sometimes the pain will travel sideways along the course of the rib.

Chiropractors call this “having a rib out”.

A rib out at the 4th thoracic vertebra on the left side (almost immediately between the shoulder blades) will cause pain to go right through the heart into the chest. The person will think they are having a heart attack.

I calculated one day that during my years of practicing chiropractic since 1983, I have adjusted over one-half million ribs.

The Lumbar Spine

The lumbar spine is the lowest portion of the spine, usually called the “low back”.  As with joint entrapment in the rest of the spine, entrapment on the lumbar spine is terribly painful.

It occurs in the facet joints, which are small joints on either side of the spine. They are numbered from top to bottom L1/L2, L2/L3, L3/L4, L4/L5, and L5/S1. The most common level by far is the L4/L5 facet joint, which for most people is right about the belt line. Second most common is L5/S1. I occasionally see it at L3/L4 or L2/L3, but not often.

I've seldom seen it occur from trauma. It always occurs from bending over, usually to pick something up or to tie one's shoelaces or dry one's legs and feet after taking a shower. The person will be mad as hell, because they will swear they didn't do anything. They can't straighten up, and are usually bent forward and away from the pain.

The pain is always unilateral (one sided). There is point pain. The person can put a finger right on the pain.

Diagnosing it is very easy. I ask two questions. One: “How did it occur?” They will answer: “All I did was bend over.” Two: “Can you put a finger on the pain?” With an entrapped facet joint, the person will put their finger right on the point of pain, which will be the facet joint. The facet joint will be exquisitely painful to touch.

This is commonly called a locked lumbar facet joint. When you hear of someone who “threw their back out” and went to a chiropractor and he “popped their back” and gave them instant relief, you can bet the problem was a locked facet joint.

It is my opinion that by far the most effective treatment of the entrapped spinal synovial joint is a chiropractic adjustment. This is where the chiropractic profession really shines. By adjusting the joint, the mechanism of entrapment is broken free. The joint returns to normal. The person is sore the day after the adjustment, about 80% better in two days, and back to normal in about three days.

It is extremely important to treat spinal joint entrapment as soon as possible after it occurs. The longer it goes untreated, the harder it is to treat.

My experience is that the normal medical treatment for the entrapped joints described above is muscle relaxors and pain killers. It can be a long slow heal. Often the person will see a physical therapist. This treatment usually works, and I am in no way criticizing the medical doctor or physical therapist, but the process of recovery can take weeks or months, where an adjustment is much, much quicker, and a whole lot cheaper.

In my personal case, an entrapped atlanto-occipital joint went undiagnosed and untreated for 10 years, ended my career as an Air Force pilot, and certainly had a major impact on my life. The original symptom I experienced when it happened was a frozen neck. Exactly as I described above. After it went untreated, other problems developed that lead me to quit flying. Ten years after it occurred, it was corrected by a chiropractor.