Facet Joint Pain
Article by John Miller
What is Facet Joint Pain?
Facet joint pain is also commonly referred to as facet joint syndrome, facet joint disease, facet joint sprain but essentially it is the pain caused by a facet joint injury.
Your facet joints (also known as zygapophyseal, apophyseal, or Z-joint) are synovial joints between the vertebrae of your spine. There are two facet joints (left and right) in each spinal motion segment.
Biomechanically, the function of each pair of facet joints is to guide and limit movement of that spinal motion segment.
Each section of your spine has facet joints. You may hear them referred to as your cervical facet joints (neck), thoracic facet joints (mid back) and lumbar facet joints (low back).
Facet joint pain is one of the most common causes of neck pain, back pain and thoracic spine pain.
What Causes Facet Joint Pain?
Facet joint motion can be disturbed by injury. Joint motion can stiffen - known as hypomobility. Alternatively, joint motion can become excessive - known as hypermobility.
What Causes Facet Joint Hypomobility?
Facet joint hypomobility can be caused by:
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 important to stabilise and control your facet joints.
What Causes Facet Joint Hypermobility?
Hypermobility is usually caused by trauma:
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 injury or you have local muscle weakness supporting your facet joints than 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. A back facet joint injury will cause low back pain and potentially pain referred into 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 neighboring joints moving more than they normally would. This 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 movement of your spine.
How is a Facet Joint Injury Diagnosed?
The most accurate diagnosis of a facet joint injury is via a hands on examination from a physiotherapist who specialises in spinal physiotherapy. Using their professional skills they will confirm the specific facet joint problem and whether it is locked, stiff or unstable. Xrays, MRI’s and CT scan are useful to identify arthritic changes and fractures but are unable to detect a locked facet joint.
Facet Joint Syndrome Treatment
The treatment 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 be unlocked using a painless joint releasing 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 a muscle control and stabilisation program. You physiotherapist will guide you.
Please check with your physiotherapist or doctor for their professional opinion.
What Results Can You Expect?
Physiotherapy will provide the majority of facet joint pain patients with complete relief. (Hu et al 2006). Locked facet joints will normally start improving immediately post-unlocking. How they progress beyond that depend on what other concomitant factors are present. How long the joint has been locked? What caused the locking? What adjacent joint motion is available?
Based on your physiotherapists examination, they will be able to provide you with more accurate 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 are sometimes used to 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 is sometimes used in chronic cases which do not respond to physiotherapy treatment. Radiofrequency cauterizes the nerve, providing pain relief for a period of time. The downside is that the pain normally returns when the nerve regrows within a few months.
Every case of facet joint pain is different. Please check with your physiotherapist for their professional opinion. on what treatment plan is best for you.
Common Treatments for Facet Joint Injury
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