Facet Syndrome

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Reach behind you and feel the center of your low back, just above the buttocks. This is your lumbar spine. Lumbar facet syndrome is a painful condition affecting the joints in this area, called the lumbar facet joints. These are responsible for connecting the vertebrae (spinal bones) in the spine, providing it with protection, limiting excessive motion and preventing the vertebrae from locking together.

Patients suffering from lumbar facet syndrome usually complain of a well-localized pain in the lumbar spine, as well as a duller type pain in one hip, buttock or upper leg. This irritation is called referred pain, which is a type of pain that originates in one area and spreads to surrounding areas.

Symptoms of facet syndrome usually get worse when people sleep on their stomach, twist their torso, work with their arms above their head, extend backward or rise from a sitting position. All these activities expose the joints to stress that they aren't accustomed to, making them more vulnerable to injury and irritation.

Such problems usually begin after patients have a similar condition called lumbar facet irritation and don't get proper care. This condition usually develops suddenly, sometimes after a misjudged movement involving the back, like sudden twisting, or while people are recovering from a bent position. It can also be the result of repetitive twisting movements like swinging a golf club. These activities stretch joint capsules (which protect and support the joints) or jam facet joints, leading to painful swelling and inflammation. Other causes of facet irritation include subluxations (stuck or misaligned joints), poor posture, everyday wear-and-tear and trauma to the low back.

The difference between lumbar facet syndrome and lumbar facet irritation is that patients with the latter only have pain in the low back, and not the accompanying referred pain. For either condition, adequate care is an effective plan of management. Generally, healthcare practitioners attempt to relieve pain and restore function to misaligned or malfunctioning joints.

Anatomy

The spine is a complex part of your body, comprised of three main sections. The cervical spine is at the top, in the neck, the thoracic spine is in the middle and the lumbar spine is at the bottom, above the buttocks.

All three sections are made up of individual bones called vertebrae, which are stacked to form a sheath that protects the spinal cord. Lumbar facet syndrome affects the lumbar spine, which consists of five vertebrae that form a flexible, C-shaped curve. Think of the lumbar spine as a slinky, with each coil representing a vertebra. Like the coils of a slinky, the vertebrae are stacked one on top of the other and move forward and backward and side-to-side in unison.

Lumbar facet joints are at the back of each vertebra, linking them together and allowing each vertebra to work in sync with the other. This provides stability to the low back by limiting the joints' movement.

Each of these joints is lined with cartilage, a soft spongy substance that insulates and cushions, and surrounded by a capsule, which helps the vertebrae glide smoothly and provides stability to the low back. When your spine is healthy, free of subluxations (stuck joints or misalignments), and moving through its normal range of motion, the vertebrae glide smoothly, keeping them healthy and you pain free.

Problems begin when the facet joints get swollen and irritated, as a result of being subluxated and not moving properly. Subluxations are commonly a result of poor posture, everyday wear-and-tear, or the trauma of lifting a heavy object incorrectly. They prevent the normal function of the joints, decreasing their mobility and irritating surrounding nerves and soft tissues.

Patients often try shifting their posture in an attempt to find relief. But while this temporarily reduces discomfort, the resulting poor posture can trigger muscle spasms in the surrounding tissue, forcing the irritated facet joints more firmly together and making movement in the low back even more painful.

The mechanisms underlying facet syndrome are similar for everyone. Factors unique to each patient, however, determine what management techniques will work best. Your chiropractor will perform a thorough assessment to determine what factors contributed to your condition, and develop a suitable plan of care to address them.

Chiropractic Care

People with lumbar facet syndrome respond particularly well to chiropractic care, including spinal manipulative therapy, trigger point therapy and muscular release technique. These management techniques not only address pain, but also ensure that the spine and the surrounding muscles are healthy and functional.

Spinal manipulative therapy, also known as an adjustment, can correct any subluxations (stuck joints or misalignments) in your spine, enabling your joints to function properly. By applying a quick thrust with his or her hands or a device called an activator tool, your chiropractor can restore joints' normal range of motion and return joints to their proper position. This eases pain, relaxes muscles, decreases inflammation and improves joint function and movement.

Trigger point therapy is another technique your chiropractor may use. A trigger point refers to a portion of muscle that is in a state of contracture. In this state, the muscle fibers are shortened and tense, resulting in tight, painful nodules or knots. Patients with lumbar facet syndrome often experience these trigger points as a result of dysfunctional facet joints, because when the joints aren't working properly, the surrounding muscles must take over, making them tired and prone to strain.

To perform trigger point therapy, your chiropractor will press down on these nodules, usually with his or her thumb, which separates the contracted muscle fibers. When he or she releases the pressure, usually within 10 seconds, an influx of fresh blood washes out irritants (like lactic acid) and brings in oxygen and minerals, relieving pain and releasing the knot.

Your chiropractor may also use a muscular release technique to promote the growth of healthy tissue. Patients with lumbar facet syndrome often have weak, strained muscles. To compensate, the body lays down new tissue to help them remain functional. This new tissue is scar tissue, however, and usually doesn't have the same properties as healthy muscle. Over time, the presence of this tissue may cause the muscle to weaken, leading to pain and dysfunction. To perform muscular release therapy, your chiropractor will slide his or her hands along the muscle's surface, helping to promote the healing of damaged tissue.

Your chiropractor may also use physiotherapeutic devices, like interferential current (IFC). IFC is a type of electrical therapy that relieves pain by stimulating muscles to contract and dispersing excess inflammation-related fluid. It also stimulates the nervous system, causing muscles to contract, increasing blood flow to the treatment area and speeding healing.

SMT, muscular release therapy and physiotherapeutic devices are effective techniques for lumbar facet syndrome. But they're not always enough to prevent future problems. To avoid a recurrence of the condition you should speak with your chiropractor about what factors caused it and implement lifestyle changes to prevent them from causing further harm.

Facet Syndrome

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