Lower Back Pain - Facet Joints
Each vertebra has bony processes on each side that form a joint with the vertebra above and below, these are called facet joints. The role of the facet joints is to limit excessive movement and provide stability for the spine.
Pain from the facet joints may arise from several causes. An acute episode of back pain may be due to sudden excessive movement that traumatises the joint. This causes an inflammatory reaction with swelling and pain in the joint, which may last for several days.
More commonly, facet pain is chronic or recurrent in nature - that is, the underlying cause is due to long term changes in the joint, so the pain does not go away easily in a few days. In most cases with middle aged or older clients, there is a degree of degeneration within the joint, causing an arthritic type problem. "Grumbly" facet joint pain or stiffness in older clients often occurs gradually after several episodes of more acute lower back pain.
Typically, there is back pain just to one side of the spine. This is normally made worse by side bending toward the affected side or extending the spine (backward bending). The back will generally feel stiff in the morning. In some cases there may be involvement of the nerve roots which emerge from the spinal cord at the level of the problem, causing pain to refer to the buttock, groin or hamstring region. Often this problem is made worse by prolonged sitting or standing in one position.
It is important that physiotherapists look at the possible causes "up and down the chain" to find and address any stiffness, movement patterns or muscle imbalances in other areas that cause compression of the lumbar facet joints. (For example hip stiffness or a tight thoracic spine affect how you move and load lumbar spine, and may also need to be addressed.)
Depending on what your physiotherapist assesses to be your main contributing factors, typical treatment may include:
> Releasing tight or spasmed muscles using massage or dry needling
> Joint mobilization (pressing on or rotating a stiff joint), to improve
movement at the affected or adjacent joints
> Joint manipulation (cracking to help release stiff joints further)
> Recommending anti-inflammatory medication (eg Voltaren)
> Heat packs, hot showers or baths to relieve muscle tension
> Taping to limit movement, and for comfort and support early on
> Exercises and stretches to regain mobility
> Core control or pilates style exercises to help re-activate stability
around the spine and hips, or to help change posture and
movement patterns that place excess force on the injured area
> Gentle walking and/or swimming to help keep the joints moving
> Advice about avoiding prolonged sitting or driving, and modifying
work or daily tasks to limit stress on lumbar facets joints
Your GP may prescribe stronger anti-inflammatories or pain killers, for relieving symptoms.
Where there is persistent pain originating from a facet problem that doesn't respond effectively to physiotherapy, it is sometimes helpful to inject the joint with a long acting local anaesthetic and anti-inflammatory corticosteroid. Injection under imaging can give very good pain relief but will wear off after a while, and may need to be repeated.
Spinal imaging (Xray, CT scan or MRI) is usually not warranted in the first few weeks unless your GP or physiotherapist suspect a fracture, or if nerve symptoms into the buttock or leg are severe and worsening, or not responding to treatment and targetted exercises after several weeks.