A facet joint is a joint that connects two or more bones in the body and functions to aid movement. The spine is made up of many vertebral segments; the facet joints are the joints connecting each of the vertebrae. Each vertebrae functions as a three-joint complex with a large disc in the front and two facet joints in the back. It is a strong tripod design that keeps the bones linked together while allowing the spine to twist and bend. The facet joints are lined with cartilage which is lubricated in synovial fluid and covered by a joint capsule. The facet joint’s job is to provide stability to enable healthy movements. Facet joint syndrome is a painful and lingering condition that is due to damage on one or more facet joints along the spine. It is similar to arthritis and can be the cause of back and neck pain. The pain is caused by degenerative changes to the joints between the spine bones. Simply, the cartilage inside the facet joint breaks down and becomes inflamed which triggers pain signals in the nerve endings. When a facet joint is damaged, it is known as facet joint syndrome or facet arthropathy. Facet joint injuries can be caused by falling, heavy lifting, sports injury, repetitive movements, twisting or jerking sideways, bending backwards, and even car accidents.
Causes & Symptoms
The core weakness of back and abdominal muscles, often in conjunction with tight hip flexors, can underlie this syndrome, especially when there are frequent recurrences. Common causes include poor lifting and bending techniques or activities that cause the spine to over-extend or over-arch. A chronic facet syndrome is often due to arthritis or degenerative changes in the spine leading to too much compression of the lumbar joints. Associated areas of stiffness in the hips or thoracic spine may also lead to excessive pressure on the lumbar facet joints.
The onset of this type of discomfort may often be attributed to poor lifting and bending techniques, while persistent pain is usually associated with arthritis or normal age-related changes in the spine, leading to increased workload for these joints. Muscle weakness can also play a role in this condition.
Additionally, the main symptom of facet joint syndrome is pain. Several clues show whether the pain is coming from the facet joints in the spine. Facet joint pain is normally intermittent. The flare-ups are unpredictable and can occur without any inciting event or obvious cause. However, facet joint pain can sometimes be chronic.
The pain is typically a dull ache and is present directly over the spine. In the lower back, it can spread to the buttocks, but it rarely spreads to the front of the legs. In the neck, facet joint pain can spread to the shoulders and back of the head, although it rarely spreads to the arms. The pain can be felt in the arms and legs if there is the formation of bone spurs that press upon the spinal nerves. Sitting in one position for a long period of time can further worsen the facet joint pain. Facet joint pain increases in severity with a twist or bending backward. Changing position may relieve the pain; for instance, a tell-tale feature of facet joint pain is that it is relieved by bending forwards. This is because the spinal flexion posture takes the pressure off the facet joints.
Depending on which facet joint is involved, you might find it difficult to stand up straight or get out of a chair. Your posture may become hunched over, or you may need to turn your entire body to look to the side.
Who Gets Facet Joint Syndrome?
Certain risk factors linked to facet joint syndrome include the following:
- Osteoarthritis – This is an age-related breakdown of cartilage in the joints. It is most often seen in large joints like the knee and hip but can also affect any joint in the body, including the spinal facet joints.
- Occupational activities – Jobs that involve heavy lifting, repetitive movements, or poor posture may cause the facet joint cartilage to become worn out.
- Injuries – A fall, sports injury, or car accident can cause damage to one or more of the facet joints and lead to pain and other symptoms.
- Age and gender – Facet joint syndrome in the lower back region is more common among older individuals (ages 40-70) and in women more than men.
- Heredity – There have been studies showing that facet arthropathy, which is a type of arthritis, may be linked to genetics. This means people who have family relatives with facet joint syndrome or facet arthropathy are more likely to develop it themselves.
- Obesity – The risk of facet joint syndrome is three times higher in people who are overweight and obese.
How Does It Affect You? How Serious Is It?
Sometimes, facet joint syndrome causes other conditions to develop. One of the complications of facet joint syndrome is bone spur formation. Bone spurs are small bony growths that help reduce the space available for nerves in the spinal canal. This condition is called spinal stenosis. Bone spurs irritate the nerves, causing symptoms such as pain, numbness, and weakness in the buttocks and legs. Facet joint syndrome is often associated with another condition called degenerative disc disease. This disease occurs with age where the vertebral discs become worn out; they lose their flexibility and shock-absorbing ability.
Osteoarthritis can also cause a breakdown of cartilage between the facet joints. When the joints move, the lack of cartilage causes pain as well as loss of motion and stiffness. The combination of the cartilage and the fluid allows the joint to move with little friction. However, facet joint syndrome causes the cartilage to break down and the joint movement is associated with more friction. The patient loses motion and as they get more stiff, they have more back pain.
Recommended Treatment & Rehabilitation
Whilst in the process of a consultation, a spinal specialist will diagnose your pain or symptoms. The visit will begin with a physical exam and a collection of your health history. In addition, you will be asked to share the timeline and triggers of your pain and discomfort. Diagnosis of facet joint syndrome is made primarily from the history and physical exam. If facet joint syndrome is suspected, diagnostic imaging can be obtained via imaging, including X-rays, MRI scans, and CT scans. These studies may have a chance of showing a condition called facet hypertrophy (an enlargement of the joint) which would indicate the joint is under excessive stress.
A facet joint block is an injection of local anesthetic and steroid medication into a suspicious facet joint. This is sometimes performed to make a diagnosis. If there is a relief of symptoms while the drugs are active, it can confirm that the symptoms are coming from the facet joint.
After a diagnosis, a physiotherapist will design an individualized treatment plan which often consists of manual hands-on therapy, postural education, and strengthening. Typical manual therapy treatments consist of soft tissue massage and joint movements to specifically stimulate the tissue and, as a result, help decrease the feelings of stiffness and pressure. Other initial treatments will include exercises to improve the mobility of the facet joints and will then progress to a program of strength training and control of the abdominal, back, and hip muscles. Effective treatment includes specific joint mobilization, to open up or unload the facet joint and take pressure off. Deep soft tissue mobilization to the surrounding muscles reduces pain, stiffness, and tension which results from protective guarding. Initial exercises take pressure off the facet joint, and a continuing customized exercise program re-educates the core abdominal and back muscles. Studies show that a combination of mobilization and strengthening exercise significantly reduces the likely return of symptoms.
As for medications, both prescriptions and over-the-counter medications may be used for facet joint pain relief. Common oral medications include:
- Non-steroidal anti-inflammatory medications (NSAIDs)
- Muscle relaxants
Topical pain-relieving medication may also be helpful to relieve local tenderness in the lower back and / or legs. Topical medications are available in the form of gels, creams, oils, and patches, and can be purchased over the counter.
Overall, facet joint syndrome is a degenerative condition that cannot be reversed. However, the pain can be managed with stretching and strengthening exercises. Here are some exercises you can perform to help relieve facet joint syndrome:
Lying glute stretch
Firstly, lie on your back and grab your knee with the hand on the same side. Secondly, use the other hand to slowly pull your lower leg and knee towards the opposite shoulder. Make sure your knee is bent at a 90-degree angle. Finally, repeat the exercise with both legs. Keep the stretch for 30 seconds with both the left and right leg.
Lay down on your back, then alternate between elongating the left and right legs by turning the pelvis. Make sure to perform the exercise at a relaxed pace before repeating the movement 10 more times in both directions.
Lying pelvic lift
Lie on your back with bent knees and your feet placed flat on the floor. Afterwards, lift the pelvis up and align your body with your thighs. Tilt your pelvis backwards and suck in your belly button. Lastly, slowly lower your back again by placing a small part of your back into the ground.
Alternative & Homeopathic Treatment
Many at-home and medical treatments are available to alleviate the pain that originates in the lower back facet joints. These treatments that may be performed at home to relieve facet joint syndrome include the following:
- Heat application – Heat therapy can help relax the muscles and open up blood vessels to allow blood flow and oxygen to reach the painful tissues, providing nourishment. Using a heat patch or hot water bag in the morning after waking up may help ease morning pain and stiffness. Heat therapy may also be used intermittently throughout the day to keep the tissues relaxed.
- Ice application – Cold therapy can be used when the pain is acute or during a pain flare-up, such as after strenuous activity. A cold pack constricts the blood vessels, reducing blood flow to the region and numbing the pain.
- Avoid activities that can worsen the symptoms – Generally, activities that include spinal twisting, repeated bending and extending, and sitting for long periods of time, should be avoided. Bending the spine backwards may cause more strain on the affected joints and must be avoided to prevent further damage.
- Supportive brace – Whilst bracing is not common in treating facet joint pain, a brace may occasionally be used for non-threatening facet instability, such as a subluxation, to help limit spinal motion and promote healing.
- Being active – While avoiding certain activities is needed, it is also necessary to stay active in moderation.