Facet Joint Pain
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:
- 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.
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 can be an excellent form of muscle spasm relief to allow your facet joint spasm to release.
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 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.
Every case of facet joint arthropathy is different. Please check with your physiotherapist for their professional opinion.
FAQ’s about Facet Joint Pain
Common Lower Back Pain Causes
The following conditions may cause lower back pain.
- Back Cramps
- Back Muscle Pain
- Core Stability Deficiency
- DOMS - Delayed Onset Muscle Soreness
- Side Strain
- Back Stress Fracture
- Scheuermann's Disease
- Spinal Stenosis
- Stress Fracture Spine (Cricket Bowlers)