The facet joints are synovial joints which help support the weight and control movement between individual vertebrae of the spine.
The facet joints work together alongside the intervertebral discs to form a functional working unit. The facet joints direct the plane of motion at each vertebral segment which is dependant on their angle and orientation
Throughout the spine the angles and orientations differ which alters the possible movement allowed in that area. The facets have an articular cartilage and articular capsule which allow movement but provide stability. Facet joints have a nerve supply from two levels, one branch arises from the nerve root at that level and the second from the level above. When functioning correctly, facet joints move freely controlling the movement of the spine.
Facet joint disorders are some of the most common of all the recurrent, disabling low back and neck problems, and can cause serious symptoms and disability for patients. However, facet joint problems rarely involve the spinal nerves.
Facet joint pain may arise directly from the facet joint either from inflammation or nerve impingement
A correct diagnosis must await subsidence of the acute problem. Symptoms may include the following:
- Acute episodes of lumbar and cervical facet joint pain are typically intermittent, generally unpredictable, and occur a few times per month or per year.
- Most patients will have a persisting point tenderness overlying the inflamed facet joints and some degree of loss in the spinal muscle flexibility (called guarding).
Low back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg. The pain is rarely present in the front of the leg, or rarely radiates below the knee or into the foot, as pain from a disc herniation often does.
Similarly, cervical facet joint problems may radiate pain locally or into the shoulders or upper back, and rarely radiate in the front or down an arm or into the fingers as a herniated disc might.
Recurrent painful episodes can be frequent and quite unpredictable in both timing and extent. Patients are often left with the notion that this is a psychosomatic problem, and it may even be implied that “it’s all in your head.”
In the lumbar case, standing may be somewhat limited but sitting and riding in a car is the worst. So-called “limited duty” (sitting) assignments for patients with low back pain are paradoxically bad. When at its height of pain and disability, the muscle spasm is so continuous that the fatigued muscles begin to hurt themselves and a vicious cycle begins
- When the almost unpredictable painful episodes recur on a monthly basis or more often, plain anterior-posterior (front-back), lateral (side view) and oblique (off angle) X-ray films should be made and examined. Usually the abnormal facet changes can be seen. However, aCT scan can obtain more information about not only the facet joints but also other structures of the spinal segment.
Perhaps the most definitive diagnosis of facet joint pain can be made by a facet joint injection (or facet joint block), which injects the suspicious facet joints with a small volume of a combination of x-ray contrast material, local anesthetic and cortisone. Relief of the acute or chronic problem during the time of action of this combination of drugs is diagnostic.
- To break up a cycle of recurring, acute facet joint pain, a number of treatments can be used successfully. Many of these treatments give some or even a lot of temporary relief but all too often, little long-term help.
- There are a number of conservative care treatment options that can be tried to alleviate the pain and rehabilitate the back, such as:
- Successful long-term treatment involves proper exercises, with instruction by a trained physical therapist or other healthcare provider.
- Good posture (maintaining a normal curvature of the spine such as pulling the car seat quite forward or when standing at a sink, putting one foot up on a ledge, bending that knee a bit), support to the low back when seated or riding in a car (particularly in the acute phase). A very useful posture when standing or sitting is the pelvic tilt – where one pinches together the buttocks and rotates forward the lower pelvis – and holding that position for several seconds, done several times per day.
- Heat (e.g. heat wraps, a hot water bottle, hot showers) or cold (e.g. cold pad applications) may help alleviate painful episodes
- Changes in daily activities (e.g. shortening or eliminating a long daily commute), and adding frequent rest breaks
- The use of anti-inflammatory medication, such as various non-steroidal anti-inflammatories, called NSAID’s (e.g. ibuprofen) and the more recent Cox-2 inhibitors (e.g. Celebrex)
- Chiropractic manipulations or osteopathic manipulations may provide pain relief
- For the neck, a restraining collar may bring temporary relief, as may also cervical traction. A suitable supportive neck pillow is often essential and abnormal nighttime flexion positioning of the neck, such as when using a pile of pillows, is to be avoided.
- More lasting relief of the facet joint problem can be obtained by destroying some of the tiny nerve endings serving the joints. This can be accomplished by a tip freezing or an electrified hot probe technique (also known as a facet rhizotomy) performed under careful x-ray control, (or for a lesser time by a carefully controlled injection of botox toxin which treats the muscle spasm).
- In unusually severe and persistent problems, degeneration of the adjoining disc is nearly always present so the segment may require abone fusion surgery to stop both the associated disc and facet joint problems. Such surgery may be considered radical, but an untreated persistent, episodic, severely disabling back pain problem can easily ruin the active life of a patient and surgery can therefore be a reasonable choice in selected cases.
- Fortunately, for the vast majority of patients, a combination of change in life style, medication and proper exercise and posture will reduce the problem to a manageable level
PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY
At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:
Strengthening of muscle
Proper lifting technique
Sports specific training
Visit Physioline for the Consultation and treatment