Facet Joint Pain
Facet Joint Pain Help in Toronto
The back of each vertebra has two bony extensions, called facet joints, that connect the bones above and below it. Facet joints are a common source of neck pain and even headaches.
When healthy, facet joints carry 10–20% of the load on the spine.
Facet joints are essential for controlling and guiding spinal movements during flexion and extension, and for limiting excessive rotation. In doing so, they protect the discs and spinal ligaments. They also prevent forward displacement (subluxation) of the vertebrae.
Each bony facet is lined with hyaline cartilage, which has a poor blood supply. As a result, if a facet joint becomes restricted in its motion or misaligned, it may not heal well after injury. Facet joints also have synovial tissue lining, which can become pinched and inflamed, leading to neck pain and back spasm.
Each facet joint is surrounded by a capsule that has a rich nerve supply. If the capsule becomes pinched or irritated, the joint may become inflamed, and this can lead to significant pain.
Facet Joint Dysfunction:
Facet Joint Dysfunction refers to the local pain and loss of motion that may occur when a joint is sprained or injured.
Facet Joint Syndrome:
Facet Joint Syndrome involves local pain and loss of motion as a result of joint injury but also pain that refers pain to other areas such as to the neck, head, back, hips, buttocks, or thighs.
Facet Joint Degeneration:
As we age, the discs between our spinal bones become dehydrated and lose height. These changes place added stress on facet joints, which causes the joints to degenerate. Any type of trauma such as car accidents, falls, constant looking down at phones or at computers and other repetitive motions add mechanical strain, and may also accelerate degeneration.
All the above conditions may be responsible for facet joint pain that is felt locally and/ or that refers to another area.
As facet joints degenerate, new bone formations (osteophytes), irregular joint margins, joint movement restrictions, and eventual bony fusion may occur.
- Facet joint degeneration is lifelong and progressive, so early prevention can help slow its progression.
- Pain from spinal facet joints is estimated to occur in 27% to 40% of patients with low back pain.
- Degeneration of the facet joints found on X-ray or MRI imaging often does not correlate well with the intensity of low back pain you may be experiencing.
- The most common areas of facet joint pain and degeneration are L4-L5 and L5-S1 and C5-6 and lower neck.
- When facet degeneration is present in C1-2-3 areas, they often cause cervicogenic headaches.
What are the Symptoms of Facet Joint Pain?
- Chronic spine pain that may be felt in the middle of your spine or extend to one or both sides
- Pain that radiates over the buttocks, groin, thighs, but does not go past the knees
- Pain that radiates into your head, jaw or upper shoulder or shoulder blade or ribcage area
- Deep, achy pain that may be hard to localize
- Worse in the mornings, after periods of sitting, and while extending or twisting the low back
- Back spasm that may be severe where you cannot stand up straight
- Neck spasm that does not allow you to turn your head fully and with sharp, intense pain
What Causes Facet Joint Pain?
Some causes of facet joint pain include:
- History of whiplash injury, car accident, slip or falls
- Sports injuries involving impact, falls and extreme neck positions
- Using exercise equipment improperly or lifting weights that are too heavy
- Emotional stress, bad dreams, anxiety-producing thoughts, and core beliefs that go unchallenged, and difficulty feeling and/or to expressing sadness, anger, and grief, living in a fearful situation without being able to change it
- Poor sleep, sleeping in a bus/car in an awkward position or staying up late to study
- Unsupportive pillow support and stomach sleeping
- Poor posture
- Sitting at a computer for hours a day without positioning the computer screen optimally ergonomically and the desk and chair height not matching your body dimensions.
- Reading or looking down at a phone or study notes for many hours at a time
- Resting a telephone in between the neck and shoulder repeatedly
- A cold breeze/fan blowing on the neck or scrunching the shoulders up to the neck in the wintertime
- Making an abrupt or awkward neck turn or being frightened by someone
- Having a cold/allergy and sneezing and coughing a lot
- Smoking
- carrying of heavy loads or favoring carrying on one shoulder
- Inflammatory disorders
- History of performing heavy labor
- Hyperextension of the spine- for example, gymnastic maneuvers
- Extreme or sudden rotation of the spine
- Repeated flexion and or rotation of the spine
- Repetitive and excessive biomechanical strain on the joints
- Obesity
- Severe asymmetry in the way the joints connect (tropism), which may occur when there is an extra vertebra (sacralization or lumbarization), a condition found in up to 10% of people
Spinal Joint Motion Palpation and Joint Dysfunction:
One of the most unique practice skills that Chiropractors have is called motion palpation. This involves the doctor using her fingers to feel a given joint while the spine is moved in different directions. In doing so, Chiropractors can feel when a segmental joint movement has been lost or restricted.
Chiropractic Treatments for Facet Joint Pain:
Conservative treatments are recommended before facet joint injections or more invasive procedures are attempted. They may include:
- Chiropractic adjustments, manual therapy
- Pulstar multiple impulse therapy
- Deep shiatsu-type massage
- Interferential current, ultrasound therapy, or electrical stimulation
- Exercise, posture, and stretching instructions
- Ergonomic advice
- Exercises such as pelvic tilts and core strengthening
- Core strengthening exercises
- Aerobic exercises
- Education, which empowers you to take an active role in your treatment, building confidence in self-management strategies, exercise and how to prevent repeated episodes of joint pain
- Anti-inflammatory and/or muscle relaxant medications if needed, on the advice of your family physician
The Importance of Chiropractic Adjustments for Facet Joint Pain:
Chiropractic manipulation is important to restore lost segmental joint motion in the spine, and to potentially help slow down arthritic changes that can set in after a joint is injured. For most people, spinal manipulation is a very safe form of treatment with few if any side effects.
Though it is commonly stated that following an episode of acute low back pain, the chances that your pain will resolve on its own are 90%. However:
- Scar tissue often remains
- Joints no longer move properly, setting you up for repeated episodes of pain
- Your posture will likely suffer, and you can develop permanent postural changes
- You will not learn why the injury occurred
- You will not learn how to prevent it from returning
- It is theorized that you are more likely to develop Osteoarthritis in your spine by not seeking treatment
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