The facet joints are the two joints that are almost never talked about when patients enter a doctor’s office with back pain. Most often the questions go to the spinal discs that are the most common source of problems. However a significant source of back pain can come from facet joint injury or arthritis.
The lower facet joints can cause very severe and often debilitating pain in the lower back. They are most often injured in a couple of ways. With their function as hinges, injury and inflammation of these joints can be quite disturbing.
They are injured by trauma that induces whiplash type movement in the lower back. Additionally hard, sudden rotational movements can cause damage to them. Aside from injury, erosive or osteoarthritis can affect these joints very painfully.
To compound all this as we get older injuries can cause light but progressive trauma to these small hinge joints that we have in our back. At every level of our lower back we have one facet joint on each side.
Common complaints about facet joint injury
From all that the most common complaints due to this condition commonly are morning stiffness, then discomfort from long standing. This pain all settles right in the lower back. The pain from standing is most often alleviated by simply sitting down for a while.
How facet joint injury and degeneration is diagnosed:
To determine facet joint injury from pain, the initial exam involves first localized pressing on the joints directly. The patient will lie on their stomach as the doctor presses down with thumbs or fingertips on the facets to see if it causes discomfort.
In addition to that the doctor will have the patient stand and slowly lean back and make slow, rotational movements with their hips. The doctor may also press into the joints while the patient is standing.
While this is not definitive, it does give some strong clues as to how to proceed with further examination.
After the initial exam, imaging studies are the most common next step in the evaluation. First, simple x-rays may give the information needed to see if the joints are injured and what role arthritis may be playing in the joint.
If the facet joint injury may radiate pain down into the leg, more advance imaging such as an MRI may be necessary to rule out further injury elsewhere. This allows doctors to look, not only at the facets but also at the nerves to be sure there is not impingement (the dreaded pinched nerve).
Initial treatment for facet joint pain
Treatment options for facet injury and pain is pretty typical in the initial conservative stage. Anti-inflammatory medications and steroids by mouth or injection are most often initial pain relief solutions.
It’s worthy of noting that steroid injections directly into the facet joint, if it brings decisive relief, it also serves as a good diagnosis factor. The anti inflammatory effects of the steroid working in the joint is a pretty good indicator that the source of pain is right there.
Getting the patient some pain relief from initial medication allows them to enter physical therapy. This helps determine what caused the facet damage to begin with and help achieve anywhere from some to complete restoration of the joint function.
Another sometimes effective if temporary relief technique is decompression of the injured area. This is most often used in response to disc injury, but it sometimes works to relief compression on nerves from facet injury. It may be done by specific exercise or by medical traction which has come a long way from the bags of sand on a pully from decades past.
This is used to allow the patient to enter or continue functional therapy.
When the facets are significantly inflamed and the injections don’t last long, there is also sometimes the option of cauterizing the nerve to stop the pain in the joint. This is a rather severe type of treatment and is not usually an initial choice.
When the patient goes through functional physical therapy, it is important to gain knowledge about what causes the problem. Then it is necessary for them to continue and/or advance the exercises developed specifically for their strength and function after treatment for facet joint injury.