Millions of Americans suffer from lower back pain every day. Although most people have heard of disc problems and how they can cause pain, many have never heard of Facet Syndrome, even though it is one of the most common causes of lower back pain. Facet Syndrome occurs when facet joints become inflamed or degenerate, causing pain.
What Are Facet Joints?
Facets are small joints that are located towards the back of a vertebra. They are located between each vertebral segment of the spine, except the upper two vertebra in the neck. The facet joints provide stability to each vertebra and protect against excessive motion of the joints. These joints limit flexion, bending forward, extension, leaning back, and rotation of the spine. By limiting these motions, the facet joints help protect the spinal cord.
Facet joints are synovial joints, meaning they contain fluid and are surrounded by a joint capsule. This helps protect the joints since they are in constant motion. However, if these joints begin to lose their motion, they can deteriorate and become arthritic over time. Although the facet joints are relatively small, they are highly innervated, meaning they contain many nerve fibers.
What is Facet Syndrome?
Facet Syndrome occurs when the facet joints in the lumbar spine become inflamed and painful. Common symptoms of Facet Syndrome include:
- Tenderness in the lower back, especially along the spine
- Muscle spasms - this is called “guarding” as the body is trying to protect the damaged joint
- Radiating pain to the buttock and back of the leg. Facet Syndrome rarely causes pain in the front of the leg.
- Pain is typically worse in lumbar extension - leaning back
The severity of pain can vary greatly from person to person, while some people will only describe a mild, dull pain, others have sharp, excruciating pain. Those with Facet Syndrome also often experience referred pain. This pain does not follow a nerve pattern and can extend into the shoulder, neck and even cause headaches. This is an important distinction between lower back pain originating from the facets vs a disc. Pain that is caused by a disc is radicular, meaning it follows a nerve pattern.
How Do You Know If You Have Facet Syndrome?
A thorough examination can usually properly diagnose Facet Syndrome, and rule out any other causes of lower back pain. This examination should include lumbar range of motion. As mentioned above, pain is usually worse in lumbar extension in those with a facet problem. This differs from a disc related problem, where pain is typically worse in flexion, bending over, and relieved in extension. One orthopedic test that is highly specific in diagnosing Facet Syndrome is Kemp’s test. For this test, the doctor will have you sit, then move you to the side and rotate you toward the back. This test stresses the facet joints and will usually cause pain in those with Facet Syndrome.
X-rays can also be helpful in diagnosing Facet Syndrome, especially the extent of degeneration present. Unlike disc problems, MRI is generally not helpful in those with facet problems. This is because the facets contain little soft tissue, which is better visualized on MRI.
Causes of Facet Syndrome
The most common cause of Facet Syndrome is degeneration of the facet joint. This occurs over time as the joint “wears out” the cartilage around it. This causes the facet joints to rub together, eventually becoming bone on bone, which can be very painful.
Another cause of painful facets is misalignments of the spine. When the vertebra of the lower back shifts out of position, additional pressure is placed on the facet joints. Since these joints contain nerve endings, even a slight misalignment can create severe pain.
Treatment of Facet Syndrome
Since one of the most common causes of Facet Syndrome is spinal misalignments, chiropractic care is an effective treatment. By locating and correcting misalignments of the lower back, chiropractors are able to relieve pressure from the facet joints and alleviate pain. A chiropractor can also give you specific stretches and exercises to help support the spine and help keep misalignments from occurring in the future. You can find more information on chiropractic care here.
Considering the most common cause of Facet Syndrome is degeneration of the facet joints, spinal decompression is another effective treatment option. Decompression stretches the spine axially, from head to toe, to relieve pressure from degenerative joints. Since most people with arthritic facet joints also have degenerative disc disease, spinal decompression can relieve pressure from both the facet joints and the discs. For more information on spinal decompression, click here.