Facet Joint Syndrome; Facet joint Pain & Facet Joint Treatment

Welcome to the Back Pain Solutions Podcast – Facet Joint Syndrome, Facet Joint Pain & Facet joint Treatment

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Listen To The Episode Below

Episode Introduction

Lower back pain can come on suddenly or gradually and is sometimes the direct result of a fall or injury. The complex structure of the spine means even small amounts of strain can cause pain or injury. When we consider the amount of effort that our back muscles must exert for example just to lift an object off the ground, then this should be no surprise. This is even less surprising when we consider how poorly people often perform such movements. Lifting a 40-kilogram object off the ground results in up to 400 kilograms of equivalent effort on the muscles of the lower back so you can imagine the potential risks if we do not keep our back in neutral during such movements. Acute injuries in the lower back are less common than those caused by repetitive microtrauma, but poor lifting technique can result in acute episodes of pain.

In this episode we discuss lumbar facet syndrome following inappropriate lifting technique, which resulted in significant pain. Lumbar facet syndrome is a painful irritation in the posterior structures of the spine and is most commonly caused by repetitive microtrauma, resulting in chronic degeneration over time. Swelling in local tissues can cause irritation of surrounding nerves leading to discomfort. Acute events can also result in small capsular tears of the involved facet joints such was the likely cause of acute pain in this case. Patients will often experience a secondary discomfort in surrounding muscles as they react to protect the area, becoming tight due to hypertonic contraction. Lumbar facet syndrome can be treated, and managed, effectively with conservative modalities such as mobilization and manipulation alongside an exercise-based approach for longer term resolution.

Some of the things you’ll discover…

An understanding of the local, and relevant anatomy
The incidence of lumbar facet syndrome and who is most commonly affected by the condition
Characteristics of the condition and how you’re most likely to feel if you experience it
What you can expect from a clinician examining you
What is the prognosis of the condition and how can you manage discomfort over the long term?
What the treatment options are for lumbar facet syndrome

Episode Highlights

Lumbar facet syndrome is a common cause of lower back pain as a result of repetitive micro trauma leading to degeneration. People can experience acute episodes of facet syndrome as a result of poor lifting techniques, or movement, although there is often underlying degeneration already present. The condition can be managed effectively with conservative management which can effectively reduce symptoms. Some patients will benefit from long term management to maintain mobility within the involved joint structures, alongside exercise and education to improve posture and reduce the risk of acute events.

Episode Transcription

Intro 0:00
When we’re young, we move with freedom and confidence with a great resilience to injury. But somewhere along the line we develop poor habits and become more vulnerable to back pain, back pain solutions features evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better back health through movement. So join us as we demystify some of the commonly held beliefs about back pain and build your confidence to a stronger back the smart way.

Ben James 0:28
Welcome back to the back pain solutions podcast Everybody with me, Ben James, another solo show today focused on lumber for syndrome we’ve got a message through via the contact form on our website, someone asking about this condition have been read online about their back health and doing a bit of research. They’ve got a chronic condition with a with an acute episodes effectively, and they were questioning whether lumber for set syndrome could be the source of their pain. So I thought it’d be a good opportunity to jump on the show and talk about this topic specifically. So what is lumber for set syndrome? what’s the what’s the anatomy involved? And what are some of the treatment options for that condition? And what’s the kind of pain pattern and could that be? What this patient or this individual specifically is suffering from? Well, let’s talk about it on the show. lumbar for set syndrome effectively is a painful irritation of the posterior part of the lumbar spine specifically, but it can affect joints throughout the spine, for set joints are posterity located throughout the spine. So vertebra stacked on top of one another in between those vertebra or intervertebral disc. And at the back, you’ve got articulations or facet joints that limit movement and help to stabilize joint and that kind of three joint complexes is very stable as a structure. The facet joints like with many of the joints around the body are our sinovel joints. So they’re small synovial joints with articular cartilage, synovial, membrane, capsule and ligaments, but just on a smaller scale to something like the knee or the hip, but they allow a reasonable amount of movement. And that movement differs depending on where you are in the spine. So in the neck, for example, we’re able to rotate our heads on our neck because of the orientation or the angle of those four set joints in that particular part of the spine in the middle of the back to the thoracic spine, that rotational movement is far more limited. And that’s to some degree because of the ribs. But also again, because of the orientation or angle of those four set joints. And similarly down in the lumbar spine in the lower back. The movement in terms of rotation and lateral flexion is is more limited. And that’s because we weren’t taking a lot more weight in that part of the body. So we want to limit that motion. So flexion extension are more common, or shall we say that the range of motion is is greater in lumbar spine for flexion extension than in rotation or lateral flexion side bending. And you’ll notice that when you’re leaning backwards, your movement is far more limited than it is when you’re flexing or bending forwards. And that’s because of the approximation or compression if you like of these joints. As you move into extension they kind of jam together to limit movement far more than when you’re flexing forward and those joints are gapping effectively and then you’re limited more by soft tissues such as the ligaments and the muscles throughout the lower back. So, back in the 1970s studies were done on lumber facettes in German injecting say line solution into the joint complex into the small joints and recreated pain and in many instances that it was noticed that there was referred pain as well into the buttocks and down the leg as well with the with lumber for set pain. And so definitely the Freesat joints can be a source of pain, a common source of pain for a lot of people. And often what you’ll find is that the pain and discomfort is a chronic condition. with acute episodes. That’s a classic pain pattern. For a lot of individuals suffering from back pain and for pain, as a source of discomfort can give a similar pattern. The capsules, kind of the membranes around that joint can become inflamed and cause discomfort they can cause local nerve root irritation as well and cause discomfort and radiating symptoms. But that’s far less common than the classic ridiculous apathy that you’ll get with a herniated disc when that nerve is really irritated and inflamed. So the referral pattern of the first section itself is generally far less than with a nerve root kind of irritation. But they certainly can get Cause referral symptoms, which is why history taken in an examination is so important to differentiate between the source of the pain and discomfort. But with facettes syndrome, often what you’ll find is that it’s very specific, it’s unilateral. And so it can be quite well identified with a good examination where and which side that joint or number of joints are irritated. So for example, if you’re looking at somebody with a, for set syndrome, or for set joint pain in the right of the lower back, what you’ll find generally is, the rotation to the right, and bending lateral bending to the side of discomfort is more painful than away from that doesn’t that’s not to say that moving away from the side of discomfort doesn’t cause some irritation. But Jen tends to be far less than moving to the side of discomfort, and patients often are, and telegenic. And what saying there is that they’re, they’re kind of leaning away from that side of discomfort to give them self some relief. So often, you’ll get these classic signs and symptoms with this condition that can be very well located and palpation. So pressing on those joints, as part of the examination often elicits discomfort, again, specific to the joints in the area that are irritated and effective, affected. So it can be very well localized, what you’ll tend to find with patients with them number for set syndrome is that they are they find a lot of relief from from moving. And walking classically is always beneficial. We always say to patients suffering from back pain, within tolerance, obviously, getting up and walking and moving is so important in particularly with a lump of syndrome that, again, is is very much relevant. What we also find is that compared to something like a disc herniation, patients with a four set syndrome do find relief from from bending the legs, or bending at the knees and bringing their knees to the chest, because that’s always something that we were skeptical, and we want to avoid because it causes flexion and can irritate discs. So you’ve got to be really careful with that, because some disc patients will, we’ll get some relief from that movement, but it’s more the stretch reflex that gives them that pain relief. And actually, it’s not helping the underlying condition. So I’ve got to be careful with that. But the legs to the chest with four sets and trim gaps, those joints a little bit and gap in the joints and getting some movement through the joints can aid with relieving those symptoms quite effectively. So, again, as always good history, good examination is going to elicit the source of the pain but with facettes syndrome, you should with a good history and examination find that that is is is well diagnosed by whoever you choose to see for your pain and discomfort. And it can be managed very effectively with conservative treatment. Now, as I say, often you’ll find acute episodes on a kind of chronic background of discomfort. So often you’ll see degenerative changes to the articular cartilage of on the surface of those four set joints or physiol joints, as they’re actually more commonly known, can lead to degeneration and discomfort. But really, the degeneration itself isn’t the direct cause of discomfort and pain. It’s the it’s the changes by mechanically mechanically that ultimately aggravate the tissues around it that caused the discomfort. So there might be a background of pain for a while and you get acute episodes of restriction and tension. But it can be managed very effectively with with conservative management and mobilization and manipulation all help to increase the movement through those juicing get and restore movement through those small joints that can help improve that range of motion and certainly help with with pain reduction. Similarly, something like a flexion distraction type treatment technique where the bench, the treatment bench that that you may be treated on will move up and down so the lower part of the bench moves up and down and the practitioner will put a bit of pressure on the joints in the low back for example and traction that bench down that helps to get those joints and again that can can be really beneficial and effective in reducing symptoms. Like with a lot of back issues we want to be focused on exercise in the long term restoring motion, healthy motion healthy movement. So we’re protecting the joints and we’re helping to condition and build endurance of the surrounding muscles to support the spine. And that should be the goal with any good battery rehabilitation program. So whilst there might be chronicity with that back pain, getting back and restoring movement Encouraging movement not being fear avoidance is all very, very important. And the same with lumber facettes in trade, so a pretty short episode, they’re focused on lumber for set syndrome, what is it? What does it do and ultimately, like I say it, it’s certainly a source of of pain and discomfort. And, clinically, the bottom line is, it’s a dysfunction often of the of the first set joints or posterior joints in in the spine, often the lumbar spine, but certainly it can affect the the cervical spine, the neck as well. And those changes and that dysfunction can lead to pain, but it can be very, very well managed with conservative treatment. So if you think you’ve got that condition, or you’re concerned that maybe those joints are affected and causing you pain, then seek out some advice, seek out some help, because in doing so you can get a lot of relief from your pain symptoms pretty quickly. But as always, make sure that you’re incorporating exercise into that rehabilitation plan so that you can be sure that you’re helping to avoid any further episodes or discomfort as a result of any changes that may occur those joints. So as always, we encourage you to get on over to the website, www dot smart strong dot code at UK. Fire any questions over happy to answer them and jump on the show and answer those questions and talk around subject matter of interest to people. And as always we ask you to head on over to iTunes and give us a rating give us a review. It helps to spread the word spread the message as we continue to develop content for the show. And as always, thank you for listening and we’ll catch you again on that show.

Transcribed by https://otter.ai