Facet Joint Pain or Facet Syndrome

 

 

 

Facet Syndrome, or Facet Joint Pain

 

Facet Joint Pain (also known as Facet Syndrome) can be debilitating. The patient can be in severe pain and have difficulty moving. It can be extremely unpleasant to say the least!

Although it is one of the main causes of back pain, facet joint pain only accounts for 5 – 10{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999} of all back pain. But this increases to nearly 45{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999} if you are between fifty and sixty years of age.

Facet joint pain usually starts with a sudden onset, and often as a result of a specific activity. Sports and movements that involve rotating or twisting are common causes of facet joint pain (such as tennis and golf).

Often the patient will say something along the lines of ‘I just bent over to pick up my shoe, and my back went and I couldn’t move!’

 

So What Are Facet Joints?

The facet joints sit at the back of the spine (the spinal discs sit at the front aspect of the spine). The facet joints are synovial joints. Just like your knee or the knuckles in your hand, they allow movement between two bones. In the case of facet joints, this is the movement between each vertebra.

In a synovial joint, the ends of the bone are covered in cartilage, like you would see at the end of a chicken bone. This shiny smooth tissue allows the bones to slide against each other almost friction free. The joint is held together by ligaments and a joint capsule. The inside of the joint cavity contains synovial fluid, like all synovial joints. This fluid lubricates the joint for smooth movement.

Most of our spinal movements (bending, reaching, twisting) occur thanks to our facet joints. They come in very handy!

 

What Is Facet Joint Pain?

The facet joints can be become injured, and therefore inflamed, as a result of injury or arthritis. Injury usually results from the joint being over stretched as a result of a twisting or reaching movement.

Arthritis, which can be seen on X-ray, CT scan or MRI, is result of degeneration of the joint. It is my belief that degenerative change is the result of chronic inflammation due to the facet joint not moving correctly (incorrect movement patterns). This is usually the result of a previous injury to the joint.

I want to point out again that is very hard to isolate exactly what is causing your back pain, as different causes often have the same symptoms and usually there is more than one culprit at play simultaneously.

However, typical signs of facet joint pain are:

  • The pain is on one side only. Often the patient can point exactly to the involved facet joint.
  • The pain had a sudden onset with a specific movement or activity. If you are over fifty, the pain may have come on more gradually.
  • The pain is worse if you lean backwards (or extend your spine).
  • Stiffness or difficulty getting out of a chair.
  • Dull pain into the buttocks or leg (but never past the knee).
  • Increased pain when you twist your back, like turning to look over your shoulder.

A common diagnostic tool for facet joint pain is to inject the joint with a local anaesthetic and an anti-inflammatory. This often brings immediate welcome relief.

However this test is notoriously inaccurate and does not have much scientific proof! So what do you do?

When I diagnose facet joint pain it is using a thorough history and physical examination. But you can never be 100{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999} sure, even with X-rays and the like.

If it looks like facet joint pain, then it probably is. But don’t rule out other possible contributing factors!

 

 

Treatment of Facet Joint Pain.

The most common medical approach, often after a diagnoses from injecting anaesthetic, is to inject steroids into the facet joint to reduce inflammation. This has mixed degrees of success in relieving the pain, and if successful it is usually short-lived (because it doesn’t fix the CAUSE of the facet injury). Steroid injections are also fraught with complications. Leg numbness and an increased risk of osteoporosis are known side-effects.

Another medical approach is Facet Rhizotomy or radiofrequency denervation or ablating. Basically, burning the delicate nerves to the facet joint! This has varying results at best, plus you want to be 100{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999} sure of the diagnoses before you start killing nerves! They are there for a reason.

Physical Therapy. Although there is not a lot of research to support it, chiropractic adjustment (or manipulation) to restore normal movement to the facet joint is widely known to be a very effective method of treating facet joint pain. There is some research that suggests patients recover quicker, and enjoy longer lasting results under chiropractic care. For some this might be controversial, but I personally would rather try more natural avenues before I burn off some important bits, or put any risky chemicals in my body!

At the end of the day, facet joint pain is probably a lot more common than the 5-10{95f364b8aea3ba4afb976a81c1dcc2e8147daac1866ef443968911255633a999} mentioned above. If you have injured a facet joint, the steps to recovery are essentially the same as for any back problem. Reduce inflammation, then strengthen and stabilise the area through following a suitable exercise plan. Simple as that.

 

If you have any questions, or would like to share your own experience, please leave us a comment below.

Also, if you have found this article helpful, please share it so we can help even more people! Thankyou.

 

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6 Comments

  1. Hi there, I must say that I have never heard of facet joints before but the way you have presented this post is really good for someone who needs such treatment. I like the fact that you have answered some of the many questions that might arise especially about what they are and how to treat the pain. Lovely post indeed.

    I wish you all the best…keep up the good work!

    • Hi Peter,

      I am glad you found my post informative. As a chiropractor I have treated thousands of people with facet joint pain. It responds very well to the correct treatment.

      Have an amazing day Peter!

      Dr Brad

  2. Hi Dr. Brad. I’ve been experiencing some back pain lately, but I don’t think it’s facet joint pain. The cause seems to be sitting down for most of the day at work. Every so often I’ll stand up to stretch out, twist around, and go for walks to loosen everything up. This really seems to work. The pain is mainly in the middle of my back off to one side of my spine. Could this be facet joint pain, or just some soreness from maybe sitting the wrong way, or both? I’d love to hear your thoughts. Thank you.

    • Hi Matt,

      It could be facet joint pain, but it is more likely to be either muscular pain or disc pain.

      It is important to understand that the pain is not the problem though. Pain occurs when the tissues are under stress and strain, the real trick is finding what is causing that stress and strain. Have a look through my articles from the top menu and you will find some info on sitting and how that can cause back pain.

      Basically sitting puts our spine into an unnatural posture for extended periods of time. Our body’s response to this is to tighten muscles in an effort to stabilise the spine. This can lead to muscle strain and soreness. Also, hunching forward puts a lot of pressure on the spinal discs, possibly leading to disc bulges and tears.

      Watch your posture when you are sitting and be sure to take regular breaks.

      All the best,

      Dr Brad

  3. Hi Dr Brad
    I had to run to my medical dictionary to know what some of the words were. Not that it’s a bad thing. I have also had back pain from a hip injury. I was sent first to physio, horribly unsuccessful, not keen on chiropractic methods, although I have heard not all chiropractors are equal…I went for a fairly new type of treatment with a kinesthesiologist. It was the best thing I ever did. I would be curious as to know how your treatment compares. Methods in certain professions in other countries can be very different, that is why I ask. I live in Canada. One thing I was grateful for was that she taught me how to manage the pain when it would return and she did tell me it would return, not necessarily often, but there would be days. If I have pain, I simply do the pain exercises and within a very short period of time it is gone. I love that part.

    • Hi Sandra,

      This reminds me of the old joke:

      Q. What do you call the medical student who passes at the bottom of his class?
      A. Doctor.

      You are right that not all chiropractors are created equal. But then neither are doctors, physiotherapists, chefs, car mechanics etc.

      I see my job as a chiropractor is to get the spine moving as best as possible for that person. Usually I can do this with quite gentle techniques, sometimes it does require a bit more force, BUT it is ALWAYS within what each individual can comfortably tolerate.

      I also see my job as a coach. Teaching and motivating people to help themselves. I can adjust spines all day long, but unless they are doing something themselves to protect and strengthen their own spine, they will always have problems. Just like I did.

      It is a very common scenario. That is exactly why I developed the Treat Back Pain Naturally system. It guides people exactly where they need to go and what they need to do. From the basics of relieving back pain to advanced exercises for optimal spinal strength and flexibilty. It is the ‘homework’ that I give to my clients who are willing to put in the tiny effort it requires to get lasting results for themselves.

      Thanks,

      Dr Brad

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