Are You Experiencing
Facet Joint Pain?

Facet joint pain of the lumbar spine is more common than is sounds. If you’ve experience specific right or left lower back pain, facet arthritis or injury may be the cause. If this sounds like you, you’ll need to know what to do to get out of pain and back to feeling like you again.




What is the Facet Joint?

Each vertebra attaches to the one above and below it via facet joints. Because of this structural arrangement, there are two facets for each vertebra on the left side and two on the right side. It is through these joints that movement of the spine occurs. These joints, like many joints of the body, can become stiff and inflamed, causing both pain and limited mobility.


Spinal Facet Joints


Causes of Facet Pain

Compression of these joints is generally the main cause of joint pain. Sleeping in a “funny” position, extended standing, jumping, and running can all cause joint excessive compression.

As we age, the discs that separate each lumbar vertebra become thinner. Over time this can lead to increased facet compression. Chronic compression or previous injury can lead to facet arthritis and pain.


Symptoms of Facet Pain

Pain associated with these spinal joints follows a specific pattern. Generally the pain is only on one side of the lower back. Depending on the specific joint involved, the pain can radiate into the buttocks or even into the groin region. Symptoms radiating down the leg are not a common symptom with facet issues unless there is also component of spinal stenosis.

Because compression of the joint is generally the problem, activities that increase joint compression cause pain. Such activities can include walking, jumping, standing, and extending the spine backwards. Side bending toward the side of your pain can also reproduce symptoms.

As inflammation of the joint is part of the problem, stiffness and pain is present when you first get up in the morning. Pain is often reduced by “decompressing” the joint by flexing forward. Sitting and bending forward therefore helps to relieve the low back pain.



Typical Conservative Treatment

As the cause of facet pain is compression and inflammation, treatment involves decompression and reducing inflammation. As with many conditions involving inflammation, anti-inflammatory medication is often recommended (consult your doctor regarding medication). In significant cases, your doctor may recommend a cortisone injection.

Utilizing ice therapy is also a treatment of choice. To reduce inflammation, ice your back 10 to 15 minutes at a time, two to three times a day. To help open compressed joints, try utilizing ice while in the 90-90 position.


90-90 position


Minimizing aggravating activities is also a key treatment component. Avoid extended walking and standing. Stop all running and jumping activities until the pain resolves. Instead, chose activities that do not involve weight bearing such as riding a bicycle.


Physical Therapy

Manual physical therapy can be very effective in reducing facet compression and improving joint mobility. Manual joint mobilizations, soft tissue massage, and the use of modalities such as ultrasound can be greatly helpful in reducing pain caused by the facet.

Because joint compression is a component of facet pain, reducing joint compression must be achieved in order to reduce pain. This decompression or “opening” of the joint can be achieved by flexing the low back. Stretching exercises involving bending should be incorporated into your daily routine. Core strengthening exercises involving the abdominal muscles can also be done. However, avoid lower back strengthening as spine extensor activity can increase compression adding to facet joint pain.

Click here for more detailed information regarding facet joint pain exercises.

Another means of helping to reduce joint compression is to use an inversion table. A typical means of utilizing the table includes hanging at a minimum of a 45 degree angle and hanging for 30 seconds up to a few minutes.


inversion traction


Facet pain is a condition of the lower back that can be managed. Follow these recommendations and you can help yourself get out of pain.



References

J Biomech Eng. 2011 Jul;133(7):071010. Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. Jaumard NV, Welch WC, Winkelstein BA.

Pain Pract. 2010 Sep-Oct;10(5):459-69. doi: 10.1111/j.1533-2500.2010.00393.x. 12. Pain originating from the lumbar facet joints. van Kleef M, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, Mekhail N.

Skeletal Radiol. 2011 Feb;40(2):149-57. Epub 2010 Jun 26. The lumbar facet joint: a review of current knowledge: Part II: diagnosis and management. Varlotta GP, Lefkowitz TR, Schweitzer M, Errico TJ, Spivak J, Bendo JA, Rybak L.


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