If you are a patient at Performance Health Center, you have probably heard your doctors use the term facet syndrome to describe the cause of your pain syndrome. But what is facet syndrome?
Have you ever been physically active over the weekend then the next day reach for a container in the refrigerator and “throw” your back out, or wake up after sleeping in a strange position and you cannot turn your neck? You hope then pain will go away but it doesn’t? Both scenarios are examples of pain caused by irritation, inflammation or dysfunction of facet joints in your spine.
So what are facets joints? There are 24 vertebrae in your spine. There is a disc between every 2 vertebra which very simple works as a shock absorber and is in front of the spinal canal where your spinal cord runs through. The facet joints are behind the spinal canal. There are 48 facet joints in your spine, 2 between each vertebra and are about the size of your small finger nail. If you feel the bumps along your spine (the spinous process), the facet joints are about 2 inches (+ or -) below the skin on either side of the bumps. Facet joints allow motion in your spine and have different orientations at different levels of your spine to facilitate movement. When you injure your ankle it swells up and you can see it. When you injure or sprain a facet joint it also swells, but because of their depth below your skin you do not see the inflammation, but you feel the pain and restricted motion.
When the facet joints swell they can make the size of the hole (foramen) where your spinal nerves exit your spine smaller which irritates (or pinches) the nerve. The small and large muscles around the joint then go into a protective spasm which also causing pain and reduced motion. This causes the joint to become immobile, a term also called dysfunction, or in chiropractic we call a subluxation.
So how do you know if your spinal pain is caused by a disc injury or facet? They both are very painful and affect your ability to participate in life. Clinically we find that most patients who present in pain have facet syndrome. According to the World Health Organization 90% of low back pain is “no-specific” which in my opinion means facet syndrome. Even when patients present with MRIs showing disc injury, my clinical exam usually rules out the disc as the pain provoker.
Facet syndrome in the neck and upper back region can cause the pain to travel into the shoulders and arm. Facet syndrome in the lower back can cause the pain to travel into the buttock and leg.
So how do you know if the pain is coming from a facet joint? The most obvious to me is watching a patient bend forward (flexion) or backwards (extension). With facet syndrome extension is always limited and often painful. Flexion is usually close to normal and not painful Our motion palpation examination for intersegmental spinal motion will find loss of motion at the effected joint(s). Classic orthopedic and neurological testing is usually normal which is why the label “no-specific” is used by the medical community.
Facet syndrome can happen in any region of the spine. The cause can be macro trauma, or more commonly micro trauma such as poor sitting, bending or smart phone technique over an extended periods of time (days, weeks, months or years). Usually injured facets feel better with motion and laying your back with your knees bent. It is made worse by sitting, especially soft chairs and couches. If your spinal pain is caused by facet syndrome, the best home care is to ice! Just like you would a sprained ankle, you need to ice your spine. The best way to ice is 20 minute on, wait at least an hour and repeat. Put a damp paper towel or thin cloth between the icepack and skin so the cold penetrates.
Chiropractors are experts in diagnosing and treating facet syndrome. The quicker you call our office and start treatment, the quicker you can enjoy life again.
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