Facet joint syndrome, also known as facet syndrome and facet joint sprain, is a common cause of back pain. This condition is regularly treated in our chiropractic clinic. The facet joints are located at the back of the spine and create the necessary motion for spinal function and mobility. There are two joints at each level; one on each side of the spine. The facet joints are synovial joints, which are enclosed within a joint capsule. There is synovial fluid within the capsule and the joint surfaces are covered with cartilage. The role of the facet joints is to control excessive movement, especially in rotation and backward bending. This enables them to provide stability for the spine. Injuries to the facet joints can be the result of many causes, but essentially it is a sprain to a ligament. The injury is caused by excessive movement, which causes damage to the joint capsule, which results in pain, swelling and inflammation. The pain, in turn, causes a reactive muscle spasm, which is a protective mechanism to limit movement at the injury site. This results in pain and an inability to move comfortably. The pain level often depends on the severity of the injury, similar to an ankle sprain. The pain from joint sprains is usually most severe for the first few days and then gradually begins to subside. When you sprain your ankle it is easy to rest and support it, but it is much more difficult to protect the facet joints from further injury, because they are in constant motion while your body is moving. Many times, patients say that they had already tweaked their back before the onset of severe pain, which suggests that they injured an already injured joint. If the sprain is severe, it can take several weeks to subside. The healing time for a damaged ligament or joint capsule is usually 2 to 6 weeks.
Facet injuries are usually caused by repetitive injuries. Essentially, the spine is a long chain of joints which are surrounded and protected by ligaments and muscles. If some of the links in the chain stiffen up through injuries, or bio-mechanical changes, it causes other links to move more, in order to compensate. Eventually, the overuse of the flexible joints causes pain through injury to the tissue/sprain. Most injuries are caused by recurrent micro-trauma. This means many small, repetitive injuries accumulate until the ‘last straw’ occurs. That is why you hear about people who hurt themselves while doing very trivial things; such as bending to pick up a sock. They frequently hurt themselves before they even get to lift the sock. Facet injuries do not have to involve heavy lifting and are more often caused by awkward or improper movements.
Signs and symptoms of facet syndrome, typically involve pain on just one side of the spine. The pain is usually felt to the side and lower than the actual site of the injury. The referred pain, from the lower spine, is sometimes felt in the buttock, groin or down the thigh. Referred pain from the facet joints in the neck can be felt over the neck, shoulder and arm, and the referred pain from the mid back is usually felt along the ribs , giving rise to rib pain. Even though rest and inactivity help to alleviate the pain, the back will generally feel stiff in the morning and after inactivity. Sometimes inactivity aggravates the muscle pain; so therefore, it is best to alternate rest with moving and walking around.
A doctor is usually able to make a diagnosis based on the patient’s medical history and the signs and symptoms of the condition. You cannot diagnose a facet joint sprain with an x-ray, a CT or an MRI-scan alone. The diagnosis is made on the clinical findings, but an x-ray may help to rule out other causes and help the doctor determine which type of treatment is most appropriate.
If you suspect that you have sustained a facet joint sprain, rest and use an ice pack. The initial treatment involves avoiding the movements that cause the joints to be painful, but prolonged rest is not advisable. Recent research shows that spinal manipulation, of the type chiropractors do, in combination with exercises, is the most effective treatment for both acute and chronic facet joint pain. Chiropractic treatment would normally involve early manipulation to release the muscle spasm. The manipulation is not done to the injured joint and the most appropriate treatment method will be chosen to avoid aggravating the problem. Patients should not expect the chiropractic treatment to be painful. Also, doing exercise long term is extremely important for creating more support and stability for the spine. In some cases, ‘curing’ the problem might not be possible, but the goal of the treatment will be to make sure the problem stays manageable, allowing you to do your normal daily activities.