What are lumbar facets?
Lumbar facets, also known as zygapophyseal joints, are motion-restricting joints in the low back. Facets of one vertebrae contact the facets of another vertebrae and slide against each other to create motion in your spine.
“Lumbar facet syndrome” describes acute or chronic inflammation of a lumbar zygapophyseal joint. The facet joint is thought to be the source of pain in 15-45% of patients with chronic low back pain. (1-7). The term “facet syndrome” shares many common characteristics with segmental joint dysfunction.
Causes of Facet Syndrome:
- Repetitive capsular stress or other cumulative low-level trauma is the most common origin of facet syndrome. (8)
- Excessive compression and extension of the lumbar spine (especially in the presence of degeneration)
- Acute or repetitive trauma leads to inflammation and joint dysfunction, including intra-articular adhesions and degenerative changes of the facet joint. (9)
Symptoms of facet syndrome:
- The most frequent complaint associated with facet syndrome is lower back pain with pain in the flank, hip, and thigh. (8)
- Facet pain generally presents on one side of the low back with peak intensity over the affected joint. (14-17)
- A complaint of stiffness or morning stiffness may be associated with degenerative change of the facet joint. (14-17)
- Symptoms of facet pain may present following an acute injury but are more commonly the result of cumulative trauma.
Risk factors for the development of facet syndrome include (38):
- a history of trauma (repetitive micro trauma or one incident)
- reumatoid arthritis
- psoriatic arthritis
- being overweight.
- postural imbalances
- lower crossed syndrome.
Painful ranges of motion:
Range of motion testing will likely elicit pain in extension, as this causes compressive loading of the facets. (10,14,18,19) Extension combined with lateral flexion or rotation generates maximal compression of the facet joint and is even more likely to reproduce symptoms. (14,18,20)
Is X-ray or MRI needed?
Evidence-based recommendations from the American College of Physicians (ACP) and the American Pain Society (APS) suggest that routine spinal imaging of benign lower back pain may be unnecessary. There are no radiographic findings that can identify the lumbar facet joints as the source of the patient’s symptoms (21). Furthermore, radiographic findings do not correlate with facet-generated symptoms (14,22-26). Guidelines suggest “imaging only for patients who have severe or progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition, or if there are signs of “red flags”” (27).
- Research has demonstrated that spinal manipulation alone is superior to alternate options including: traditional medical management (muscle relaxants, pain meds, anti-inflammatories), physical therapy, mobilization, pain management, exercise, and bed rest (28-42).
- At Creekside, a combination of treatments is generally used to attain the best results
- Doctors may choose to implement modalities in the initial phase of care as part of a passive-to-active multimodal approach. (43)
- Heat, ice, ultrasound, and e-stim may help relax muscles and provide short-term palliative relief in the early phases of facet syndrome treatment. (44)
What treatments are not very effective?
- American Family Physician reported that in spite of increasing use, “anticonvulsants like gabapentin (Neurontin)… are not an effective treatment for low back pain with or without radiculopathy, and are associated with an increased risk of adverse events” (46).
- Lumbar support belts are not recommended for routine use, although individual circumstances should be considered (43).
- The isolated use of electrotherapy modalities such as TENS is generally unsupported in the literature (7, 47)
What else can I do to help this issue?
- Lifestyle modifications should include removal of the activity that induces pain.
- Patients may need to limit heavy physical activity but should avoid bed rest. (45)
- Patients should be considerate of lifting mechanics, work activities, sleep positions and shoe wear.
- Minimizing of prolonged sitting and sedentary hobbies.
- Yoga has been shown to be an effective treatment for simple mechanical low back pain (48).
- The addition of NSAIDS may help reduce pain and inflammation initially.
At Creekside Chiropractic & Performance Center, we are highly trained to treat this condition. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
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