FACET JOINT PAIN OR SYNDROME EXERCISES, CAUSES, SYMPTOMS AND TREATMENT

FACET JOINT PAIN

• Facet joints are the paired joints that are located in the posterior portion of the vertebral bodies connecting the spine. 

• These joints work a part of the stabilizing mechanism for the back.

• The surfaces of the facet are smooth and flat, like the facets of a diamond this is the reason why  the joints are called facet joints,

• Facet joints are adequately supplied by nerve fibers.

• Degeneration (bone spurs) at the facet joint may narrow the neural foramen, which may lead to compression of the spinal nerve root and resulting in back or referred leg pain.

LATERAL VIEW OF NORMAL WORKING FACET JOINT

CAUSES OF FACET JOINT PAIN

• Degeneration is the most common cause

• Facet joint degeneration is a component of disc degeneration

• This degenerative process produces pain similar to osteoarthritis and also limits the mobility of the spine 

• With progressive spinal degeneration, alteration in the load-bearing patterns of the facet joints occurs.

• Fracture of facet joints can also cause facet joint pain

• Facet Syndrome: Irritation of a facet joint that may result in radiating pain from the lower back down to the leg.

• As degeneration of the facet joints occurs, lower back pain may increase. The pain caused by these joints is present in the low back only. 

• This pain may get worsen with standing or bending backward or to the side and is relieved or reduced with sitting. 

• However, as the degeneration progresses, the nerves to the joint may get more irritated and start sending signals along with the “computer network” attached to that facet joint. This is referred pain

• The signals in the network can cause tightness of the muscles in the low back, thigh, or calf. 

• Pain may be felt in the buttock, hamstring area, and lower leg. 

• If a pain is not treated for a long time, sitting or bending forward may also become difficult and may not help to relieve pain

• Pain from facet joint arthropathy may get increased due to sensitized nerves

• Facet dislocation (separation of the facet joints): Facet joint at the top of the curve gets disrupted followed by frank dislocation. More than one level may be involved.

SYMPTOMS OF FACET JOINT PAIN

• Facet joints have been considered responsible for 15–45% of patients with low back pain and mostly remain undiagnosed even with CT/MRI. 

• Facet joint pain usually has the following characteristics:

• Pain on the paramedian aspect of the spine

• Pain is predominantly on one side of the back

• Sitting and bending forward are comfortable as the facet joints are less loaded when the spine is flexed forward(forward bending)

• Sitting to standing, turning side on the bed can be painful due to stress and incorrect position

• Extension, lateral bending, and rotation produces pain as facet joints are maximally overloaded in this position

• Pain might be referred  below to leg, but that will be dispersed in distribution

• No neuro deficits is seen dominantly

• Lumbar facet joint pain may radiate to the lower limbs resembling sciatica

• Pain is produced with the extension (backward bending) of the spine.

TREATMENT FOR FACET JOINT PAIN

• Mostly facet joint pain can be treated successfully by conservative methods but if this method fails to relieve the pain then surgical methods are used.

Conservative treatment for Facet Joint Pain

• NSAIDs to reduce inflammation

• Physiotherapy

Surgical treatment of Facet Joint Pain

• Lumbar decompression

• Reduction

• Facetectomy

PHYSIOTHERAPY TREATMENT FOR FACET JOINT PAIN

• Hot or Cold Therapy

• Ultrasound

• TENS (in referred pain)

• Exercises

EXERCISES FOR FACET JOINT PAIN

LEVEL 1 EXERCISES FOR FACET JOINT PAIN 

HIP-HITCHER EXERCISE

SUPINE PELVIC TILT EXERCISE

SINGLE KNEE TO CHEST EXERCISE

KNEES-TO-CHEST STRETCH EXERCISE

BRIDGE EXERCISE

SINGLE-LEG ELONGATION EXERCISE

CAT AND CAMEL EXERCISE

CHILD’S POSE EXERCISE

LEVEL 2 EXERCISES FOR FACET JOINT PAIN (after the pain subsides)

HAMSTRING STRETCH 1 EXERCISE

KNEELING SUPERMAN EXERCISE

KNEELING PELVIC TILT EXERCISE

STRAIGHT LEG RAISE(SLR) EXERCISE

PRONE LEG RAISE EXERCISE

SIDE-LYING LEG RAISE EXERCISE

SINGLE-LEG BRIDGE EXERCISE

PRECAUTIONARY GUIDANCE

• SLEEPING HABITS: Lying on your tummy increases the curve in your lower back, which may increase back pain caused by facet joint problems

• GETTING IN AND OUT OF BED

• TURNING IN BED

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