Facet Syndrome

Facet joints are paired joints located on the posterior aspect of the spine at each level. The joints provide stability to the spine and limit excess motion. Each facet joint is lined with cartilage and surrounded by a lubricating capsule that enables the vertebrae to move freely. These joints have nerve endings both inside and outside the joints. Causes of irritation and stress to the facet joints include: misalignment, everyday wear and tear, trauma such as motor vehicle accidents, previous back or neck injuries and intervertebral disc degeneration. As with other joints they can undergo degeneration or arthritic changes.

Symptoms
Facet joints can present with a variety of symptoms depending on the location of the irritated joints. Local tenderness in the region over the joint is common. In the neck (cervical spine) pain can be present in the neck, shoulders, upper and mid back. Headaches are also possible. In the low back (lumbar spine) pain is often felt in the low back, buttocks and backs of the thigh/s. The pain is often made worse by bending backward or rotating. A protective reflex arises when facet joints are inflamed which cause the nearby muscles of the spine to go into spasm. This may lead to a limitation in muscular flexibility called guarding.

Treatment Options
Various treatment options are available for facet joint pain. In general, successful long-term treatment involves proper exercise, with instruction provided by a physical therapist or other health care provider trained in spine-care. Maintaining good posture is particularly important as is learning to modify ones activities to avoid further damage and alleviate pain. Anti-inflammatory medications also called NSAIDS such as ibuprofen and naproxen can be helpful. Manipulation can also be used to realign joints and provide pain relief. For persistent pain, X-ray guided injections can be performed to place medication directly into the joints at the source of the pain. Finally, destruction of the small nerves to the joint can be performed by trained physicians with an electrified heat probe. If successful this can provide relief for up to six months.

Prognosis
Fortunately, the vast majority of patients respond well to a combination of medications, lifestyle changes and proper exercise. Education and proper training in biomechanics are crucial. This can often reduce the pain to manageable levels. Risk factors for recurrence include poor flexibility and poor strength of neck, low back, pelvic and shoulder girdle muscles. As with other musculoskeletal conditions, the exercise should not end with supervised therapy. It should continue with a home exercise program in order to maintain an increased level of function and provide lasting pain relief.