Subfailure capsule strain as the cause of cervical zygapophysial joint pain after whiplash: a scoping review

The cause of neck pain after whiplash is regarded as unknown, but Bioengineers have published studies implicating subfailure injuries of the cervical zygapophysial joints as a leading cause of pain.

A scoping review was undertaken to determine the size and nature of the evidence for subfailure injuries as a cause of pain after whiplash.

Considered eligible were any articles that provided evidence on the nature of subfailure injuries and their ability to evoke pain or elicit nociceptive activity in the nervous system.

Articles were sought in the databases of PubMed and EMBASE. Searches were performed in March 2025 and repeated in September 2025.

The searches yielded 49 articles that described the microscopic structure of subfailure injuries, their ability to evoke pain behaviors in experimental animals, and features of persistent nociception and hypersensitivity in dorsal roots, dorsal root ganglia, the dorsal horn, and in the thalamus.

There is an abundant literature that defines subfailure injuries and shows that they evoke features of persistent nociception in the peripheral and central nervous system. Overlooked in the clinical literature, this evidence warrants greater recognition in the literature and practice of pain medicine.