Why do we get Spinal Facet Joint Pain?
Written by Chris Heywood - MSc BSc (Hons) MCSP HCPC reg
Physiotherapist
We have two facet joints on either side, at each level of the spine. They vary in size and shape but all fulfil important roles. They are a common reason for low back that we see at Team Rehab uk but why do they suddenly start to hurt and how can we help you?
Basic Anatomy
Our spines are made up of a number of bones 'stacked up' on top of each other called vertebrae and these are linked together by ligaments and muscles. These 'movable' parts of the spine can be split in to three main areas, the base (lumbar) containing 5 vertebra, the middle (thoracic) with 12 vertebra, and the neck (cervical) with 7.
The 24 moveable levels in your spine
Each vertebra, throughout the whole spine, is joined above and below to its neighbour and as a result, form a pair of small weight-bearing joints called the facet joints. These are designed to allow, but control movement in the spine.
​The joint surfaces have a fine, cartilaginous lining tissue to help with cushioning and provide protection. The size and shape of the individual vertebrae change from being much larger at the bottom, to smaller at the top. This is a consequence of, and indeed a reflection of, the larger forces that are subjected to the vertebrae throughout the lower back in comparison to those at the neck. Despite this, there is a lower proportion of pain generally attributed to the facet joints in low back pain than in neck pain, and this is thought to be due to the variations in available movement at the vertebra, and also the angle of the joint.
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The L3 vertebra sits above the L4 and come together the create the L3/4 facet joints
Why Do Facet Joints Get Sore?
Like any other joint in the body, facet joints have the potential to become sore. This could be through trauma, congenital (born with it), mechanical overload, or degenerative abnormalities. The normal presentation of simple facet joint pain is that of a generalised aching over the lower back area that may be a little more tender locally around the joint site. The pain may be quite sharp if pressed directly, or if you increase the load through the joint (e.g. bend backwards, down to one side, or a combination of them).
The achy feeling can often travel into the buttocks, or the upper leg in some cases. Although possible, it is not normally seen as a reason for pain below the knee or more nerve related symptoms such as pins and needles, numbness or muscle weakness. In simple isolated facet joint pain, it is important to highlight that the major nerves are not generally being compressed, just irritated, so the risk of long-term damage is extremely low in general.
The reason for the different types of pain we feel is down to the body having numerous ways of recognising, and reporting potential, or actual bodily injury to the brain. It the case of facet joint pains we may feel a slow onset achy pain, generally considered to be the result of inflammation, or a fast intense pain where an immediate response is needed, such as stopping you leaning backwards (compressing a sore joint) beyond a certain range.
Does Facet Joint Pain Get Better?
Most facet joint irritations are self-limiting and react well to simple conservative management such as medication, physio, education and/or exercise. If they are not settling however, or you are struggling with the symptoms, they are one of the most common reasons for back pain that we see a Team Rehab uk, so we are well placed to provide you with any help that you need.
The treatment can be varied depending on the exact presentation but most commonly would consist of:
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Assessment and explanation of findings
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Self-management techniques
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Joint mobilisations (We are not bone crackers)
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Soft tissue release
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Targeted exercises for your particular case
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Ice/heat regimes
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Taping if appropriate
Although a vast majority of simple facet joint symptoms will respond to our treatments, in cases where pain persists you may need further diagnostic tests. Unless you have a history of fragile bones, certain types of auto-immune conditions, trauma or very specific symptoms, investigations such as X-rays are pointless. They will not normally provide any information that will help with the diagnosis or treatment, but you will be irradiated for your trouble. Imagery techniques such as MRI Scans are the most common starting point and onward management will then be decided based the results. Please do be aware however that these simply look at anatomy and do not necessarily come complete with a big arrow pointing to the reason for your pain.
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If you are diagnosed with facet joint pain, but self-management and physiotherapy has not helped, you may then be referred to a consultant as well. They will be able to determine whether semi-invasive techniques such as facet joint injections, medial branch blocks or even nerve denervation may be appropriate. In most cases these will still not provide a long term 'magic bullet' cure and we often tend to view them more as providing a period of temporary relief in which to enable conservative interventions, such as physiotherapy, to work more effectively.
To avoid the potential for over treatment by health professionals, whatever the reason behind it, we would advise that if you are not seeing increasingly lasting benefits from any type of therapy input after 4-6 sessions, that you seek a second, or specialist opinion. You may not be fixed by then, but you should be seeing a trend that clearly shows you are likely to respond to the treatment positively.
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