What is Facet Joint Syndrome?

When we think about our joints, it’s the larger ones that usually come to mind: hips, knees and shoulders, for example. We rely on them to keep us moving, but we generally don’t think about them unless they aren’t working well.

We do have other joints, however, that are equally important to our well-being, although we’re not usually aware that they exist. They are called facet joints and are located on the back of the spinal column.

Each vertebra has two facet joints, one on each side of the spine. They are the joints responsible for spine stability and flexibility and make it possible for you to bend and twist.

The facet joints in each area of the spine are angled and shaped differently in each region of the spine: cervical, lumbar and thoracic. When they are healthy, they are cushioned by cartilage, allowing them to move smoothly against each other and are lubricated by synovial fluid to prevent wear and tear.

Like any joint, your facet joints are subject to injury or pain. When these joints become painful and swell, the result is called facet joint syndrome.

The joints can also be injured; the stiffening of facet joints is called hypomobility; excessive joint motion is called hypermobility. Facet joints can also lock in place, impeding movement in the opposite direction.

Facet joint syndrome can generally be attributed to the combination of injury, excessive pressure and aging. Discs in the spine can degenerate and collapse, affecting the alignment of your facet joints. The misalignment wears on the cartilage, which is eventually destroyed, along with the lubricating synovial fluid, leaving bone rubbing on bone.

Facet joint problems are common causes for neck, back and thoracic spine pain. Generally, 55 per cent of facet joint syndrome sufferers have pain in their cervical (neck) region, while 31 per cent have problems in their lumbar (back) area.

Unfortunately, facet joint inflammation can be confused with other conditions. In the cervical region, the symptoms may be similar to those of a herniated disc or a torn spine muscle. Abdominal problems and neck issues may also mimic the symptoms of facet joint issues, so a careful diagnosis is imperative.

Symptoms of facet joint problems may include:

• Acute, intermittent episodes of pain in the lumbar or cervical regions of the spine that occur a few times a month or year;
• More discomfort when leaning backward than forward;
• Low back pain that radiates through the buttocks and the back of the upper legs, but not the front of the legs or below the knees;
• Pain in the shoulders and upper back that doesn’t affect the arms or lower back; and/or
• Pain points above the facet joints and loss in spinal muscle flexibility.

If you have facet joint syndrome, you may have difficulties in bending or twisting your spine. Issues with the facet joints in your neck may make it challenging to turn your head left or right, while problems with facet joints in your back may make rising from a chair hard to accomplish. Lumbar facet joint syndrome will also make sitting and riding in a car challenging.

Facet joint syndrome will be diagnosed by your physician based on your symptoms, your history, an examination and tests: an X-ray, a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan.

Your physician will probably refer you to a physiotherapist to help you rehabilitate your joints, restore your range of motion and alleviate your pain.

Your physiotherapy treatment will generally include a course of exercises to restore movement, strength and flexibility, along with soft-tissue massage; acupuncture is also an to alleviate localized pain. Potentially, spinal traction and joint manipulation will also be recommended.

Your physician may also suggest non-steroidal anti-inflammatory drugs to alleviate pain quickly and prescribe muscle relaxants. If the pain continues, your physician may give you a steroid injection for temporary relief.

Although facet joint syndrome is partially a consequence of aging, it is possible to make lifestyle choices that reduce your chance of developing it as you age. By exercising regularly, maintaining a healthy weight, eating a nutritious diet, practising good posture, and avoiding tobacco and excessive alcohol consumption, you can slow down the forces that cause it.