Lumbar facet syndrome
Pain in the facet joints of the lower back

There are many structures that can cause lower back pain. The facet joints are increasingly being identified as a major cause of lower back pain. The pain may manifest in various ways, but is usually on one side radiating into the thigh.

The lumbar facet syndrome is a collective term for symptoms of the facet joints.

Description of condition

The vertebrae of the back are stacked bony structures that combine to form the spinal column. The vertebrae are interconnected at the rear by two facet joints. At the front, the vertebrae are connected through intervertebral discs.

The facet joints and the intervertebral discs ensure that the vertebrae can move in relation to each other. They also contribute to the overall stability of the back.

Facet joints and intervertebral discs are weight-bearing structures. A lot of forces are exerted on the facet joint particularly when stretching the back.

As a result of symptoms of wear and tear, which cause the intervertebral discs to become thinner, more forces are exerted on the facet joints. This may make the facet joints irritated and inflamed, which can result in pain.

It is estimated that 15-52% of patients with chronic lower back pain have a problem with the facet joints. However, it is only in 4% of cases that the facet joints are the sole cause of the symptoms. Therefore, problems with the facet joints are usually accompanied by disorders of other structures such as intervertebral discs and muscles.

Cause and history

Lumbar facet syndrome falls under the heading of degenerative back pain. This means that degeneration is its main cause. Degeneration refers to the fact that the quality of tissue decreases. This can be caused by the natural aging process, but also by strain or a change in position of the spine.

As a result of strain or a modified position of the spine (such as scoliosis), the strain on certain facet joints can become too much, which may lead to symptoms.

Tissue that is strained is of reduced quality. Straining is not always the result of heavy work. If the back is always held in the same way, for example by sitting for a long time, then the strain on certain points is constantly too much, which can lead to strain. This is also the case with single-sided movements or incorrect use of the lower back and abdominal muscles.

Facet joint symptoms may also be caused by trauma. This includes falling backward or a traffic accident.

Signs & symptoms

Symptoms originating from the facet joints can display different characteristics:

• Pain on one side of the lower back (unilateral), sometimes on both sides (bilateral).
  
• Pain when stretching (arching) the back.
  
• Pain when stretching and turning (looking over the shoulder).
  
• The pain may radiate to the groin, front, side or back of the thigh.
  
• Pain when pressure is applied to the lower back.
  
• The pain often subsides when bending forward.
  
• Increased muscle tension in the area of the facet joints. With unilateral symptoms, only on one side.
  
• Running and swimming may provoke the pain.
  

The area where pain radiates to gives us information about the location of the facet problems:

• Radiating pain to the flank and the side of the thigh may indicate facet problems high in the lower back.
  
• Radiating pain to the back of the leg indicates instead facet problems low in the lower back.
  

With facet problems there is rarely any radiating pain below the knee. If this is the case, we are more likely to be looking at problems with an intervertebral disc, such as a hernia.

Diagnosis

The diagnosis of facet pain is not straightforward, mainly because a combination of causes is often present in chronic back pain. To make the diagnosis, the list of symptoms and the findings of a physical examination are used.

Pain provocation and the radiating area play a major role in making the diagnosis. During the physical examination, a check is made whether the pain can be provoked from the facet joints.

If necessary, an X-ray guided nerve block procedure may be performed. The pain perception of certain facet joints is temporarily switched off. If this provides relief, then the facet joints are involved.

Treatment

Physiotherapy treatment consists of exercise therapy and the application of mobilization techniques. Pain relief is provided using medication. If necessary, muscle relaxants may be prescribed to reduce muscle tension.

As discussed earlier, facet pain is a degenerative disease. For optimum treatment, it is therefore important to examine what might have caused the degeneration. If this is due to a one-sided posture and one-sided movements, the treatment will be adjusted accordingly.

If the natural aging process plays an important role, we will examine how the facet joints can be spared as much as possible. This can be done by guaranteeing the mobility of the joints and by increasing their weight-bearing capacity through exercise therapy.

Exercises

It is important to continue to move in the right way and do exercises for these symptoms. That is why we offer you an exercise program here with exercises for lumbar facet syndrome.

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your locality.

References
Hestbaek, L., Kongsted, A., Jensen, T.S. & Leboeuf-Yde, C. (2009). The clinical aspects of the acute facet syndrome: results from a structured discussion among European chiropractors. Chiropr Osteopat. 2009; 17: 2.
Kleef, M. van, Vanelderen, P., Cohen, S.P., Lataster, A., Zundert, J. van & Mekhail, N. (2010). Pain originating from the lumbar facet joints. Pain Pract. 2010 Sep-Oct;10(5):459-69.
Magee, D.J. (2014). Orthopedic physical assessment. Elsevier saunders: St. Louis.
Meeusen, R. (2001). Rug- en Nekletsels deel 1: Epidemiologie, anatomie, onderzoek en letsels. Cluwer, Diegem. p 122- 124.