Facet Joint Pain
Article by John Miller
Facet Joint Arthropathy
What is Facet Joint Arthropathy?
Facet joint arthropathy is also commonly referred to as facet joint syndrome, facet joint pain, facet joint sprain, but mostly it is a pain caused by a facet joint injury. Facet joints are synovial joints between the vertebrae of your spine. Biomechanically, the function of each pair of facet joints is to guide and limit the movement of that spinal motion segment.
You may also hear facet joint arthropathy described as a zygapophyseal joint syndrome. Your facet joints are also known as zygapophyseal, apophyseal, or Z-joints.
Each section of your spine has facet joints. You may hear them referred to as your cervical facet joint pain (neck), thoracic facet joint pain (mid-back) and lumbar facet joint pain (low back). There are two facet joints (left and right) in each spinal motion segment. Facet joint arthropathy is one of the most common causes of neck pain, back pain and thoracic spine pain.
What Causes Facet Joint Arthropathy?
Facet joint motion can be disturbed by injury. Joint action can stiffen – known as hypomobility. Alternatively, joint movement can become excessive – known as hypermobility. All of these fall within the category of a facet joint arthropathy.
What Causes Facet Joint Hypomobility?
Facet joint hypomobility can be caused by:
- locked facet joint,
- facet joint arthritis,
- degenerative facet joint osteophytes (bone spurs),
- joint capsule scarring, thickening or shortening, or
- protective muscle spasm.
In other words, a facet joint can stiffen due to a slow degeneration or due to uncontrolled motion, which is where your local muscle strength is vital to stabilise and control your facet joints.
What Causes Facet Joint Hypermobility?
Hypermobility is typically traumatic or repeated microtrauma in origin. Traumas may include:
- fracture,
- dislocation,
- overstretched ligaments, or
- a disease that destroys the joints, e.g. Rheumatoid arthritis.
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 facet joints motion exceeding your muscle control.
If you have previously suffered an injury or you have local muscle weakness supporting your facet joints, then it is even easier to repeated 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. A neck facet joint will cause neck pain and potentially shoulder or upper arm pain. Acute cervical facet joint lock can result in an acute wry neck. A back facet joint injury will cause low back pain and potentially pain referred to your buttock or thigh.
When a facet joint locks, you may not be able to move in the direction away from where it’s locked. For example, if the joint is locked in a flexed forward position, you will probably have difficulty arching backwards. The opposite also occurs. In acute phases, muscle spasm will attempt to protect the injured facet joint.
The initial injury can sometimes occur days or occasionally weeks earlier. Your body will attempt to compensate for the locked joint by the neighbouring joints moving more than they usually would. This abnormal movement can often cause pain on the opposite side to the locked facet joint and may potentially lead to other conditions such as sciatica or arm pain. Most commonly, you will notice decreased movement and pain or difficulty stretching.
People who have this problem recurrently are said to have facet joint syndrome. The most common cause of facet joint syndrome is weak stability muscles that are failing to control the movement of your spine.
How is a Facet Joint Arthropathy Diagnosed?
A hands-on examination from a skilled physiotherapist can diagnose facet joint arthropathy.
Using their professional palpation skills, they will confirm the specific facet joint arthropathy and whether it is locked, stiff or unstable. Xrays, MRI’s and CT scan are used to identify arthritic changes and fractures but are unable to detect a locked facet joint. Degenerative changes within the facet joints are commonly called spondylosis.
Please consult your physiotherapist for specific advice regarding your facet joint arthropathy management.
More information
- Cervical Facet Joint Pain (neck)
- Thoracic Facet Joint Pain (mid-back)
- Lumbar Facet Joint Pain (lower back)
Facet Joint Arthropathy Treatment
Specific treatment will vary depending upon your particular facet joint arthropathy. The procedure for a locked facet joint is relatively simple. Your physiotherapist will quickly detect which facet joint is locked. Then proceed to unlock it. Usually, a locked facet can unlock using a painless joint release technique.
The next step is to regain full motion and commence strengthening or other exercises to prevent a future, recurrence. Everyone is slightly different, so your treatment will vary depending on what deficits your physiotherapist has found during your examination.
Unstable Facet Joint Treatment
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 is unlikely to assist a hypermobile facet joint.
These patients respond better to muscle control and stabilisation program. You physiotherapist will guide you.
Please check with your physiotherapist or doctor for their professional opinion.
Facet Joint Arthropathy Treatment Results?
Physiotherapy will provide the majority of facet joint arthropathy patients with complete relief. (Hu et al. 2006). Locked facet joints will usually start improving immediately post-unlocking. How they progress beyond that, depend on what other concomitant factors are present. How long has the joint been locked? What caused the locking? What adjacent joint motion there is available?
Based on your physiotherapist’s examination, they will be able to provide you with more strict guidelines. Facet joint instability will take longer to rehabilitate since they require time and practice for your muscle strengthening to occur. Once again, please check with your treating physiotherapist for their professional opinion and treatment plan.
Other Treatment Options
Massage
Massage can be an excellent form of muscle spasm relief to allow your facet joint spasm to release.
Acupuncture
Localised acupuncture or dry needling techniques can provide localised muscle spasm and facet pain relief. Ask your physiotherapist for more advice.
Facet Joint Injections
Facet joint injections m confirm a diagnosis and provide short-term (a week or two) relief. Researchers have found that facet joint injections are less effective than patients who exercise in the long-term. (Mayer et al. 2004)
Radiofrequency
Radiofrequency may assist chronic cases which do not respond to physiotherapy treatment. Radiofrequency cauterises the nerve, providing pain relief for a while. The downside is that the pain returns typically when the nerve regrows within a few months.
Summary
Every case of facet joint arthropathy is different. Please check with your physiotherapist for their professional opinion.
What Causes Lower Back Pain?
Introduction
Lower back pain is a widespread issue in Australia, stemming from diverse conditions. As physiotherapists, we often encounter various causes of this pain. This guide aims to shed light on these causes and provide valuable insights for effective management.
Muscle-Related Injuries
Muscle injuries are a predominant cause of lower back pain, including:
- Back Cramps and Muscle Pain: Typically resulting from overuse or strain.
- Core Stability Deficiency: Weak core muscles can lead to increased back strain.
- DOMS (Delayed Onset Muscle Soreness): Soreness affecting back muscles post-exercise.
Recent research underscores the importance of regular exercise and core strengthening in preventing these injuries.
Bone-Related Injuries
Bone health is crucial in lower back pain, encompassing conditions like:
- Spondylosis: Degenerative spine conditions.
- Spondylolysis or Stress Fracture: Common in athletes, such as cricket bowlers.
- Spondylolisthesis: Occurs when a vertebra slips over another.
- Osteoporosis: Causes bones to weaken, increasing fracture risk. Advancements in bone density scanning have improved early detection and management.
- Scheuermann’s Disease: Affects spinal bone growth in teenagers.
- Scoliosis: An abnormal curvature of the spine causing pain.
- Spinal Stenosis: A narrowing of the spinal canal leading to nerve compression.
Disc-Related Injuries
Spinal discs are vital for spinal health:
- Bulging and Disc Protrusions: These discs protrude or "slip" and can press on nerves.
- Herniated Disc: A more severe form of disc protrusion.
- Degenerative Disc Disease: Age-related disc wear and tear.
Minimally invasive surgical techniques have transformed the treatment of severe disc-related injuries where physiotherapy and other non-operative options fail to improve.
Back Joint Injuries
- Facet Joint Pain: Arises from arthritis or stress on these spinal joints.
Nerve-Related Injuries
Nerve issues can lead to:
- Nerve Pain and Pinched Nerves: Caused by spinal nerve compression from disc bulging or arthritic changes.
- Sciatica: Irritation of the sciatic nerve.
Physiotherapy and newer medications have been effective in managing these conditions. Some will require injection therapies or surgery.
Pelvis-Related Injuries
Pelvic issues also contribute to lower back pain:
- Sacroiliac Joint Pain: Involving joints connecting the spine to the pelvis.
- Piriformis Syndrome: Where the piriformis muscle irritates the sciatic nerve.
Pregnancy-Related Pain
- Pregnancy Back Pain: Often due to increased back strain during pregnancy. Prenatal physiotherapy programs are beneficial.
Systemic Diseases
Systemic diseases like Ankylosing Spondylitis, Fibromyalgia and Rheumatoid Arthritis can cause back pain.
Recent Research and Advancements
Current research emphasises a holistic approach to treating lower back pain. Techniques like yoga and Pilates, alongside traditional physiotherapy, and conservatively progressed gym programs show significant relief. The role of diet in managing weight and inflammation is increasingly recognised.
Best Treatments for Lower Back Pain
Treatment varies but often includes:
- Physiotherapy
- Pain management
- Strength and flexibility exercise programs
- Ergonomic adjustments
- Surgical interventions for severe cases
Conclusion
Lower back pain is a significant health concern in Australia. Understanding its causes and seeking professional physiotherapy advice can greatly improve life quality. Remember, early intervention is key for an effective recovery.
What to Do?
If you're experiencing lower back pain, it's vital to consult a physiotherapist or doctor. They can provide an assessment and customised treatment plan based on your specific condition.
Back Pain FAQs & Products
Your Comprehensive Guide to FAQs, Causes, and Relief
Experiencing back pain and looking for answers? Our comprehensive FAQ section covers everything you need to know about back pain - from common causes and symptoms to effective treatments.
Click the links to our detailed articles to understand better and manage your back pain. Explore links to related topics like 'Severe Back Pain Management', 'Posture Improvement Techniques', and 'Physiotherapy for Chronic Back Issues' for a holistic approach to your spinal health."
What Causes Back Pain?
Discover the various factors behind back pain, including muscle strains, herniated discs, and more.
- Most Common Causes of Back Pain
- Causes of Lower Back Pain
- Causes of Upper Back Pain
- Understanding Herniated Discs
- Osteoarthritis and Back Pain
- Back Stress Fractures
- Pregnancy Back Pain
How Can I Relieve Back Pain?
Explore treatments ranging from physiotherapy to exercises, tailored to alleviate back pain.
- Best Treatment for Lower Back Pain
- Physiotherapy for Back Pain
- Exercises for Back Strength
- Could Ultrasound Physiotherapy Help You Beat Back Pain?
- Benefits of Back Massage
Can Back Pain Be Prevented?
Learn how to prevent back pain through healthy habits and proper body mechanics.
- Preventing Back Pain Tips
- Proper Back Posture Guidelines
- Regular Exercise Routines for Back Pain
- Gym Back Exercises
When Should You See a Physio or Doctor for Back Pain?
Understand when it's crucial to seek professional medical advice for back pain.
- Severe Back Pain? Causes, Symptoms & Treatment
- Warning Signs of Severe Back Conditions
- Physiotherapy Consultation for Back Pain: What to Expect?
Repeated Bouts & Incidental Back Pain FAQs
Addressing frequently occurring and sudden back pain incidents.
- Causes of Recurrent Back Strains
- Understanding Sudden Back Pain
- What Causes Back Pain for No Reason?
- What Causes Repeat Low Back Strains & Sprains?
Youth Back Pain FAQs
Focusing on the prevention and management of back pain in teenagers.
Back Pain Exercises FAQs
Discover effective exercises and tools for back pain relief.
- Core Strengthening Exercises
- Exercise Balls for Lower Back Pain and Core Stability
- Is Walking Good for Back Pain?
- Pilates for Back Pain
Back Pain Prevention FAQs
Key insights into everyday activities and their impact on back health.
- Walking and Back Pain
- Handling Recurring Back Pain
- Healthy Weight Maintenance for Back Pain
Posture FAQs
Learn about the importance of good posture and techniques to improve it.
- Importance of Good Posture
- Correct Sitting Posture
- Improving Standing Posture
- Healthy Sleeping Postures
Other Treatments For Back Pain?
Investigate a variety of treatments, from nerve blocks to spinal cord stimulation.
- Epidural Steroid Injections
- Nerve Blocks for Pain Relief
- Spinal Cord Stimulation
- Surgical Options: When to Consider Surgery?
Conclusion
Empowering you with knowledge to understand, address, and prevent back pain effectively.
What to Do Next
Now that you've gained insight into the causes and remedies of back pain, it's time to take the next steps. Start by applying the prevention techniques and exercises detailed in this guide to your daily routine. If you're currently experiencing back pain, consider the treatment options discussed and consult a healthcare professional for personalised advice. Remember, every journey to back health is unique.
Stay informed, be proactive in your self-care, and don't hesitate to seek professional help when needed. For further reading, explore the hyperlinked articles to deepen your understanding and support your path to a pain-free life. Here’s to taking control of your back health and embracing a more comfortable, active lifestyle.