Definition

Lumbar facet joint irritation or damage that may cause referring pain up into the back as well as down into the associated leg.

Aetiology

  • Lower back pain in the general population is approximately 65%
  • Chronic lower back pain (defined here as pain lasting 6 months or longer) is approximately 26%
  • It is estimated that 33-75% of lower back pain complaints have a lumbar facet component

History, signs and symptoms

  • Injury of the muscles, ligaments and joint capsule of the lumbar spine
  • Lumbar disc injuries are associated with facet joint pain in about 50% of cases
  • Repetitive stress, poor posture (occupational)
  • Pain is often quite localized
  • Described as a dull aching pain (may be sharp on movement)
  • Pain may radiate to the legs and/or upper back regions
  • During physical examination pain may be increased on extension, lateral flexion and rotation (due to facet joint approximation)
  • Antalgic list is typically away from the facet joint in acute cases
  • Possible muscle splinting and guarded ROM
  • Neurological examination is unremarkable

Management

  • Facet syndromes respond very well to joint adjustments and mobilisation
  • Soft tissue massage, ischemic compression and myofascial dry needling
  • Also rest, ice, heat
  • Passive (stretching) and active range of motion exercises to be performed in a pain free range
  • Strengthening
  • Medications such as NSAIDs and analgesics (cataflam or nurofen syrup) for pain control and muscle relaxants (norflex)
  • Ice application first 48 hours after injury (20 minutes each our)
  • Heat application after 48 hours of injury

Facet joint anatomy

Each vertebra has two sets of facet joints. One pair faces upward (superior articular facet) and one downward (inferior articular facet). There is one joint on each side (right and left). Facet joints are hinge–like and link vertebrae together. They are located at the back of the spine (posterior).

Facet joints are synovial joints.

This means each joint is surrounded by a capsule of connective tissue and produces a fluid to nourish and lubricate the joint. The joint surfaces are coated with cartilage allowing joints to move or glide smoothly (articulate) against each other.

These joints allow flexion (bend forward), extension (bend backward), and twisting motion. Certain types of movement are restricted. The spine is made more stable due to the interlocking nature to adjacent vertebrae.

Because the joint allows for flexion, extension and rotation, they can also easily get stuck in this position resulting in back pain especially when trying to sit or getting up from a chair.