Lower back pain affects nearly 60 % of the population at some stage in their lives. Lower back pain can be caused by many factors including vertebral disc problems, muscular strains, poor muscular balance caused by poor posture, osteo-arthritis (“wear and tear”), stress fractures and nerve irritation (e.g. sciatica), but more commonly involved by facet joints and the surrounding ligaments and soft tissues.
The human spine is made up of 24 vertebrae excluding the sacrum and coccyx. Between each vertebra is a disc and the disc acts as a shock absorber. At the back of the spine, each vertebra connects to the vertebra below through bony projections which form the facet joints.
The facet joints allow and guide movements at different levels of the spine. In the lower back (spine), the facet joints allow for forwards (bending forwards e.g. to touch your toes), backwards (aching your back) and sideways (e.g. sliding your hand down the side of your leg to your knee) movements.
Each facet joint has ligaments and muscles that support the joint. When we bend backwards or sideways, the facet joints are compressed or closed down. When we bend forwards, the joints open up and it puts the ligaments on stretch.
Facet joints can be injured by movements e.g. sudden twisting, bending or when lifting or pushing something heavy. The damage occurs when the joints are overstretched and the surrounding ligaments, muscle and/or joint capsule are injured, causing inflammation and pain. It is common to have associated muscle spasm and stiffness in the surrounding muscles.
The facet joint can also be injured by poor posture when the ligaments are overstretched which places the facet joints under constant strain. Because muscles fatigue easily, they cannot provide the adequate support to protect the joints under prolonged stress.
“Wear and tear” (degeneration) of the joints associated with increasing age, can cause the breakdown of cartilage and bone within the facet joins. As a result, inflammation causes pain as the body tries to repair the structures. The body’s attempt to heal the degeneration is not possible, but treatment of the resulting inflammatory condition may bring relief.
Signs and symptoms of a facet joint injury include pain usually more towards one side of the lower back (but can also be on both sides). The person will complain of a constant ache, but sometimes the ache is also associated with sharp stabbing pains with some movements. Quite often the pain may be felt in the buttocks or legs on one side, but most of the time the pain is localised to the site of the injury. Lower back stiffness particularly in the morning is common, as is sharp pain when getting in or out of the car, on when rising from sitting to standing.
Treatment initially aims to reduce the inflammation by gentle movement and rest from aggravating factors. The use of anti-inflammatories can be helpful in this stage as prescribed by your doctor. The second phase of treatment is to restore “normal” movement and to reduce by pain and can include Physiotherapy treatments such as mobilisations, manipulations, traction, soft tissue massage and the application of heat. A gentle exercise programme involving stretches and gentle strengthening of the muscles that support the spine is very useful. Usually the facet joints respond very well to treatment and heal quickly within 7 to 10 days. When the injury is caused by long standing problems e.g. poor posture or by multiple factors, the recovery may be slower and incomplete. Your Physiotherapist will be able to provide you with an accurate diagnosis and treatment plan to optimise your recovery.
Antoinette Stickling
