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Facet Joint Syndrome

About Spinal Facet Joint Syndrome

Facet joint syndrome is a common cause of back pain. A severe acute episode of facet joint pain may be due to sudden movement, which traumatises the facet joint. More often, facet pain, or Facet Syndrome is chronic in nature - that is, the underlying cause is due to long term changes in the facet joint that are often associated with repeated injuries and degenerative disc disease.

The facet joints are situated at the back, on either side of the spinal column, between the discs and the vertebral bodies. Each vertebra has bony prominences on each side that form a facet joint with the vertebra above and below. The facet joints are enclosed within a joint capsule and research has shown that in the lower back there can be a 'meniscoid' (cartilage disc) structure within the joint space, just like a mini version of the meniscus in the knee joint. The role of the facet joints is to limit excessive movement and provide stability for the spine.

Symptoms

Typically, there is back pain just to one side of the spine. This is normally made worse by side bending toward the affected side or extending the spine (backward bending).

The back will generally feel stiff in the morning.

In some cases there may be irritation of the nerve roots, which emerge from the spinal cord at the level of the problem, causing pain to refer to the buttock, groin or hamstring region. This is known as sciatica. In other cases, the pain may be felt in the front of the thighs.

Often this problem is made worse by prolonged sitting or standing in one position.

The diagnosis can usually be made based on the history of the condition, and the presence of the signs and symptoms listed above. If there is any doubt, or if the pain does not resolve with treatment, it may be necessary to have an x-ray of the spine. A CT scan or MRI scan may also show the problem.

Treatment

Acute joint sprain: Follow R.I.C.E protocol. Stop the activity, rest in a comfortable position, preferably lying down and apply ice or a cold pack for 10 minutes every hour for 6 hours to reduce internal bruising to the muscle. The nearby muscles may tend to spasm for the first two or three days after injury. Alternate hot and cold compresses can help to ease the spasms. Avoid over-working the back for several days but do try to continue with as near to normal activities particularly walking to keep the area actively healing. See Ligament Sprains.

It is important to keep the region warm to relieve back pain and muscle spasm, but preferably using clothing, a pad or pillow avoiding hot water bottles or similar as these tend to cause congestion of the area.

Rest, non-steroidal anti-inflammatory (NSAIDs) drugs e.g. paracetamol, aspirin or ibuprofen should help settle the problem in a week or two.

Massage may help to ease the pain but care should be taken not to relax the surrounding muscles too quickly as this may lead to more severe reflex spasms as the back is attempting to protect the joints form further injury.  

Gentle osteopathic mobilisations help to clear the inflammation from the joints and ease the tenderness.  If the joint is ‘nipped’ manipulation may be used to free the joint.

Mild to moderate joint sprain: This is usually noticed the next day when there may be significant pain and stiffness on getting up in the morning. A warm shower or bath, especially with Epsom salts will help to ease the stiffness. See the Hydrotherapy page. Again refrain from the offending activity but do keep on the move.

Osteopathic manipulation of the joint with a controlled thrust will reduce muscle spasm, free off nerves, open up the facet joint and break down early scar tissue, which may limit movement.

Memory tape strapping or a Back Brace can provide reassurance and support to the lower back.

Causes of Facet Joint Sprain

Back pain from the facet joints may arise from several causes: a sudden accident including falls, jerks or car crash can cause facet joint ligament sprain if the surrounding muscles don’t contract quickly enough to protect the area.

Poor posture where the back is in one position for along period (usually flexed forward) e.g. sitting slumped or bending whilst working or gardening may cause the back muscles to become excessively tired and the ligaments close to the facet joint to become stretched. Then, when you try to stand up straight, the muscles do not behave properly, the facet joint may not straighten correctly into their proper position and become ‘nipped’ or ‘locked’.

Several theories have been put forward, including nipping of the facet joint capsule or the meniscoid tissue between the two bones. This may be mild or severe at the time but, as with trauma to any such joint, there is an inflammatory reaction with swelling and pain in the joint, which causes pain to increase over-night and may last for several days.

With chronic facet joint pain, the underlying cause is due to long term changes in the joint, meaning the pain does not go away in a few days. In most cases there is degeneration within the facet joint, causing an arthritic type problem. This may be a long term consequence of seemingly minor trauma in the past. See our web page about Spondylosis and Spondylitis.

Rehabilitation & Protecting Your Back

Poor posture plays a major role in the development of Facet Syndrome.

Prolonged sitting and bending postures, where the lumbar spine is 'flexed' should be avoided as they increase the pressure on the discs. This can lead to disc degeneration and a loss of disc height. As the discs shrink the facet joints come into contact with each other and start to bear weight. This is not what they are designed to do.

In     order to avoid disc degeneration, and excessive loading of the facet joints, it is important to take better care of back posture. An understanding of good posture is necessary to achieve this.

Viewed from the side, the spine consists of a series of curves that increase the load-carrying capability of the spine compared to if the spine was just straight.

The lumbar part of the spine consists of a forward curve and as long as this is maintained, posture will be reasonably good. It is important that this improved posture is maintained during all activities, particularly when sitting for long periods - slumping should be avoided.

A Lumbar Roll placed at the bottom of the back or a Seating Support can be effective when sitting.

In the long term, good posture is maintained by increasing the muscular stability of the spine. The osteopath will identify muscles that have become over-stretched or shortened, weak or tense and can then teach a range of exercises and techniques that will help to stabilise the back, including improving abdominal, pelvic floor and back strength. For more information please call or ask in the clinic or visit www.back-stability.co.uk.

Healing Time

Significant facet joint sprains take 6 to eight weeks to heal, but most will be significantly better within a few days.  

However, in the case of poor posture or neglecting to avoid the activity or improve technique,  the various ligaments and muscles surrounding the facet joints may become weakened and the joint chronically swollen leading eventually to spondylosis (or arthritic changes).  Osteopathic treatment and rehabilitation can help to re-order and re-educate the muscles.

In a more chronic type of facet joint problem, particularly with arthritic changes resulting in spondylosis, regular maintenance treatment may be helpful to maintain mobility and strength. However, where there is persistent pain originating from a facet joint problem, an injection of long acting local anaesthetic and anti-inflammatory corticosteroid into the facet joint may be effective in relieving symptoms and, if successful, it confirms the diagnosis.

In order for this approach to work the injection is best done by a Consultant Radiologist under an image intensifier. This device allows the doctor to see exactly where the injection is going. This approach can give very good pain relief, but the effects may wear off after a while and of course there can be unwanted side-effects from the steroid including softening and weakening of the ligaments and cartilage. It may be necessary to repeat the procedure at a later date.