The facet joint is a true synovial joint throughout the entire spinal column (lumbar, thoracic, cervical regions).
There are two facet joints (Left and Right) in each spinal segment. They are also known as zygapophyseal, zagapophysial, apohyseal or Z-joints.
The facet joints help connect the spinal vertebra together by joining at the superior articular process of one vertebra and inferior articular process of the vertebra above. In combination with the disc, ligaments, deep stabilising muscles and big power muscles, the bilateral facet joints play an important role in transferring loads and facilitating movement throughout spinal movements.
Facet joints can occur with a gradual onset (insidious) or acute.
Acute Facet Joint Pain
When an acute incident occurs through the facet joint, this is a facet joint sprain.
A sharp pain usually occurs with a twisting action or fast action such as explosively jumping and landing on one leg, changing direction on one leg, bending forward or extending backward in an awkward position. Pain will be on one side of the lower back.
Acute facet joint sprains will initially have a sharp pain on movements. Bending forwards (lumbar flexion), backwards (lumbar extension) and twisting will bring on the sharp pain that may feel like it takes your breath away.
At rest pain may be less irritable with a dull ache present. Symptoms will be worse for the first few days after injury.
Gradual Onset Facet Joint Pain
When lumbar facet joint pain comes on without an acute incident, it is due to an increase in lumbar loading in the lead up. What has your past 2-3 weeks looked like before the pain?
Usually we see an increase in strenuous activity such as renovating the house, cleaning, training volumes (team sports or running) or gym activity (especially squat, deadlift or overhead pressing volumes). Furthermore the spine and facet joints like movement, an increase in sedentary loads - sitting or driving, may cause the lumbar facet joints to become irritated.
Symptoms from overloaded facet joints may feel ‘tight’, ‘jamming’, stiff or a dull ache. Usually lumbar extension (arching your back backwards) and rotation irritates symptoms. Sitting and driving for long periods may increase the tightness or ache.
Pain can be felt on one side, or may feel central in the lower part of the lumbar spine.
For acute facet joint sprains, relative rest is needed. This DOES NOT mean sitting or lying down all day - in fact research shows that may make your pain worse. Provocative activities need to be weaned down in the short term until the pain settles.
Very strenuous activities should be limited such as gym, team sport trainings, cleaning and renovating. Necessity day-to-day activities should be paced, with breaks taken every 20 mins before increased pain comes on.
Pain relief and/or anti-inflammatories may be beneficial in the acute stage. If you are considering this you MUST enquire with your GP or pharmacist.
Provocative movements, usually arching backwards (lumbar extension) and full twisting, should be limited in the short term.
Stretching and bending forwards may offer a short-term relief.
Once the pain settles weaning up low-level activities (such as walking) and avoiding sustained positions (sitting) should be introduced.
Physiotherapy is often needed at the acute stage for pain-relieving manual therapy, taping and mobility exercises. These may help alleviate the locked up sensation and surrounding muscle tightness/spasm.
Gradual Onset Facet Joint Pain
For this presentation of facet joint pain movement and mobility exercises is key.
Avoiding sustained positions (sitting and standing) for long periods is vital. People are encouraged to move every 30 mins and walk every day gently for at least 15-20 minutes.
Lumbar flexion and rotation are often provocative actions. These are encouraged to be avoided for the short term to allow pain to settle.
Warm showers and heat pack may help dissipate the tightness and pain.
Stretching in lumbar flexion and mobility exercises at the spin and hip are prescribed to help stretch out tight muscles and increase movement at the facet joints.
Physiotherapy may involve manual therapy to free up jamming joints and release tight guarded muscles, exercises to maintain movement at home and work, and advice regarding weaning up day to day or sporting activities.
Once facet joint pain settles, the job is not complete!
It is very important to restore full mobility, lumbar and hip strength and movement confidence after pain has ceased.
Pain and strength performance do not correlate. Strength will not be restored unless strength exercises are performed to build up tissue capacity.
The lumbar spine strength will be restored or increased. Exercises such as side planks, Russian twists, dead bugs, Romanian deadlifts or goblet squats may be utilised to build lumbar spine capacity. One goal will be to maintain a side plank for a minimum of 60 secs in females and 90 secs in males. Athletes will be expected to hold this for even longer!
A lack of hip strength often contributes to facet joint injuries.
Dynamometers are devices that can measure muscle strengths and obviously point out left and right differences. If there are any deficits, these should be restored and improved with hip strengthening exercises.
Crab walks, banded hip flexion and single leg bridges are some examples of hip exercises that can help.
Physiotherapists will act like a detective to explore why the injury and pain occurred. Was it an obvious or more subtle increase in sports, domestic or activity loading? Was there increased work pressures meaning you had to work extra hours and harder? Is there an error in your sporting or gym technique causing overload and jamming in the facet joints?
Do you have a biomechanical or strength deficit making you susceptible to facet joint pain? Sports physiotherapists will hunt around the body to find the cause!
If you have facet joint pain, or sciatica, you do not need to continue suffering though! All the physiotherapists at Melbourne Sports Physiotherapy are competent at treating the condition, management planning to get you back to your goals and preventing recurrences from happening.
If you would like to see one of our physiotherapists please follow the link and book in at your preferred location.