Facet joint pain is a particular type of back pain. It is caused by problems with the facet joints in the spine, so is not muscular in origin, although it does cause muscle spasms. It can then be treated – but not all the treatments that are useful are medical. There is a lot you can do to reduce the impact of facet joint pain on your life through behavioural changes, exercises and physiotherapy or manipulation by a chiropractor. In severe cases, and as a last resort, surgery is possible but this involves a major and delicate operation.
This article on facet joint pain is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.
What is a facet joint?
The facet joints are part of the structure of the spinal column. There are 25 pairs of facet joints located between and behind each of the vertebrae in the neck and back, except for the very top vertebrae.
The role of the facet joints is to balance the movements of the spine and limit its twisting motion, preventing damage to the spinal cord, while still allowing enough movement for you to look around, turn and twist. The role of each joint will vary depending on the movement required at that part of the spine.
Each facet joint rubs up against the adjacent joints, however because they are coated in smooth, moist cartilage and held within a sack of lubricant, the friction is kept to a minimum.
What are the causes?
Facet joint pain occurs when the cartilage that coats the facet joints wears thin through wear and tear, creating greater friction. This in turn stimulates the growth of the bone within the joint, enlarging it and causing inflammation, which presses on surrounding nerves, leading to considerable pain.
What’s more, the actual pain of the facet joint will often cause a defensive spasm in the surrounding muscles of the back, causing the torso to become unbalanced leading to further discomfort.
In severe cases, these spasms can continue for so long that they begin to damage the muscles, starting a vicious circle of further defensive spasms.
What are the symptoms?
The symptoms of facet joint pain include:
- A persistent point of pain at the inflamed joint
- Intermittent, unpredictable back or neck pain
- More pain leaning forwards than leaning back
- Back pain radiating down the back of the leg to the knee
- Neck pain radiating into the shoulders and upper back
Unfortunately, the symptoms of facet joint pain are similar to the other major cause of back problems – the herniated disc. However, there are some important differences that will help your GP to tell them apart, including the extent and location of radiated pain.
There are several ways that you can treat your facet joint pain without professional intervention. These include:
- Heat (such as wheat bags) and cold (such as ice packs) to reduce inflammation
- Anti-inflammatory medicines (such as ibuprofen)
- Changing your routine to avoid long periods sitting down – immobility always makes facet joint pain much worse
- Changing your posture with back supports and sitting straighter when driving
- Investing in good support for your neck when sleeping
You should also try to keep as active as possible, as this will help to relieve the muscle spasms and keep your back moving, so it doesn’t seize up in its attempt to protect you from the pain. Regular exercise will also help you to reduce the frequency of your facet joint pain.
During the initial facet joint pain attack, manipulations by a trained chiropractor or osteopath may help to ease the pain and relax the muscle spasms that occur as a result. Getting your back straight again will go a long way to reducing the severity and duration of the episode.
A physiotherapist may also be useful, both to train you in the best way to cope with an attack, and to give you exercises to help reduce their frequency.
The sack of fluid around the facet joint holds many small nerve endings to enable the body to monitor the joint. In severe cases of facet joint pain, surgery is used to kill off some of these nerves and so reduce the pain. This procedure is called facet rhizotomy and can be done by either freezing the nerves or cauterising them with heat.
However, this is a very delicate operation, which takes place very close to vital nerves and the spinal cord, and so it will only be recommended once all the avenues discussed above have been explored.
In extreme cases, where the joint has seriously degenerated, the two adjacent vertebrae may be fused, but this is generally only used as a last resort, where the problem is severely restricting a person’s normal lifestyle.
Living with facet joint pain
For most people, facet joint pain can be reduced to a level they can live with, or eliminated altogether by a combination of the self-treatment procedures described above.
Of these, perhaps the most important is keeping healthy and active, as this will not only reduce the impact of facet joint pain, but will also help keep your weight down so that the pressure on your back is minimised.