Facet Joint Pain: A Common Cause of Back Pain

Facet joint pain is one of the most common causes of pain in the neck, back and thoracic spine.

What is Facet Joint Pain?

Facet joint pain is also referred to as

  • facet joint syndrome
  • facet joint disease or
  • facet joint sprain.

It is the pain caused by a facet joint injury.

What is a facet joint?

You have 33 bones, or vertebrae in your spine. The facet joints are the structures that connect the vertebrae to one another.

 

 

facet joints diagram

Fig 1: This diagram shows the facet joints in your spine and how they allow you to move your body

 

 

There are four named sections of your spine. Each vertebra in each section has two facet joints.

You may hear them referred to as your

  • cervical facet joints (neck),
  • thoracic facet joints (mid back) and
  • lumbar facet joints (low back).

The facet joint is like any other joint in your body. Cartilage lines the joint to allow the bones to glide smoothly over one another. It also has a fluid-filled capsule surrounding the joint and a nerve supply.

Biomechanically, the job of your facet joints is to guide and limit movement of your spine.

 

Click here to watch a short video explaining facet joints.

 

 

What Causes Facet Joint Pain?

Injury, repetitive movements or poor posture can lead to Facet Joint Pain.

Sometimes the facet joints become less mobile and harder to move. This is known as hypomobility. Hypo is the ancient Greek word for under.

Sometimes the facet joints become too loose and move too much. This is known as hypermobility. Hyper comes from the Greek for over.

Occasionally the facet joints lock.

 

simon points out facet joints

Simon Nembhard at Castle Osteopaths explaining the structure of the spine to a patient

 

 

What Causes Facet Joint Hypomobility?

Facet joint hypomobility can be caused by:

  • An injury left untreated
  • Degenerative changes (arthritis),
  • Facet joint osteophytes (bone spurs),
  • Joint capsule scarring, thickening or shortening
  • Protective muscle spasm
  • Genetics

In other words, a facet joint can stiffen due to a slow degeneration or due to uncontrolled motion.

What Causes Facet Joint Hypermobility?

Hypermobility is usually caused by trauma:

  • Trauma/fracture
  • Accidental injury
  • Dislocation,
  • Overstretched ligaments
  • Genetics

What Causes a Locked Facet Joint?

Simple movements such as a mild twist, awkward movement or just doing something your body didn't expect (such as tripping) can lock a facet joint. In most cases this is due to your muscles not being able to control the facet joint motion.

If you have previously suffered injury or you have local muscle weakness supporting your facet joints then it is even easier to repeatedly lock a facet joint.

 

What are the Symptoms of a Locked Facet Joint?

Pain is one of the first symptoms a patient will notice with a facet joint injury. Although the pain isn’t necessarily felt at the point of injury.

For example….

An injury in the neck can cause headaches, migraines and pain that radiates down the arm.

A facet injury in the mid back can cause pain on deep breathing and can refer to the chest.

An injury to the lower back can refer to the buttock or lower leg.

 

What does facet joint pain feel like?

An acute facet pain is described as a very sharp pain that feels like a knife.  The pain is often aggravated by movement.

For example if your right acute lumbar facet is damaged: side bending to the right will be very painful and almost described as electric. Side bending to the left is much less painful. Forward bending could be very limited and also sharp on the right side. The pain is almost always one-sided.

Sometimes the pain doesn’t appear until days or even weeks after the initial injury.

Your body is very good at trying to use different muscles and joints instead of the damaged one. This can often cause pain on the opposite side to the locked facet joint. Potentially it may lead to other conditions such as sciatica or arm pain.

Most commonly you will notice decreased movement and pain or difficulty stretching.

 

How does your osteopath diagnose a Facet Joint Injury?

The most accurate diagnosis of a facet joint injury is by palpation/touch. Osteopaths are trained to examine the spine and they develop a remarkable sense of touch.

By listening to your story, observing your movements and understanding your symptoms; Simon Nembhard at Castle Osteopaths gathers clues as to where the problem may be. Then, by gently using his hands, he will confirm which facet joint has a problem and whether it is locked, stiff or unstable.

Some of the diagnostic tools you might expect a Doctor to use are not needed in these cases. X-rays, MRI and CT scan are useful to identify arthritic changes and fractures but are unable to detect a locked facet joint.

Facet Joint Injections can also be used to help identify facet joint pain.

 

using touch to diagnose facet joint problems

 

Simon uses touch and palpation to find the exact cause of his patient's back pain

 

Treatment for Locked Facet Joint Syndrome

At Castle Osteopaths in Thetford, facet joint pain is usually treated with gentle effective osteopathic manipulation, massage or distal acupuncture

Your osteopath will quickly detect which facet joint is locked. Then proceed to unlock it. Usually a locked facet can be unlocked.

The next step is to regain full motion. Then start a program of strengthening or other exercises to stop it from happening again.

Everyone is slightly different, so your treatment will vary depending on what your osteopath has found during your examination.

 

Treatment for Unstable (hypermobile) Facet Joints

Unstable or hypermobile facet joints need to be treated entirely differently to a locked facet joint. The fact that the joint already moves excessively would suggest that further joint loosening will not help at all.

Patients with hypermobile facet joints respond better to a muscle control and stabilisation program. Your osteopath will guide you and suggest suitable exercises.

 

What Results Can You Expect?

The way your body responds to treatment depends on a lot of factors. Your age, lifestyle, general health and of course the extent of the injury.

Your Osteopath will explain which the treatments he recommends for you, why you need them, how many consultations you might need.

How patients progress depends on what other associated factors are present. How long the joint has been locked? What caused the locking? What adjacent joint motion is available?

Facet joint instability (hypermobility) will take longer to rehabilitate. It takes time and training for your muscles to get stronger.

A typical facet joint pain is resolved in 3 or 4 treatments. Once again, please check with your treating osteopath for their professional opinion and treatment plan.

 

Important information about Facet Joint Pain

Your body is an amazing piece of biological engineering. With lots of component parts working together. In the human body, just like in a machine or a building, the one thing you must remember is  

Structure governs function and the two are interrelated

 

If your joint starts to get restricted it will have an effect on the adjacent joints, nerves, blood supply and muscles. If left untreated the joints will degenerate quicker from textbook normal to phase 3.  

 

Don’t leave it too long to get professional help with any kind of pain.

 

 

degeneration in joints

 Fig 2: Degeneration of spinal joints over time

 

Other Treatment Options

Facet Joint Injections

If all manual therapy has been exhausted you will need further investigation. Facet joint injections are sometimes used to confirm a diagnosis and provide short to medium term relief.

 

What to Do if you are suffering from facet joint pain

Every case of facet joint pain is different.

If you suffer spinal pain try not to delay getting a diagnosis and treatment. Chronic facet pain increases the speed of degeneration in the spine. This can lead to degenerative changes/arthritis that cannot be fixed by manual therapy or medical intervention.

In other words, get it fixed before it causes permanent damage.

Please check with your osteopath as soon as possible for their professional opinion on what treatment plan is best for you.

 

References:

References:

Fig 1.

Dr. K Bridwell (1999) ‘Facet Joints of the Spine's Anatomy’, spine universe (Accessed.. 1-12-2016) (online) [www.spineuniverse.com]

Fig 2.

Dr M Carrol (2013) ‘spinal degeneration’, Nebo chiropractic (online) (Accessed..1-12-2016) [www.miltoncarrolldc.com]

 

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