Facet Pain

Where are the Facets?

The facets are joints located toward the back of the spine. You must understand a little more about the spine, to understand what they do and how they can become painful and cause facet syndrome. Facet syndrome is thought to be responsible for at least 20% of back pain in the population over 65 years old. You are probably most familiar with the facet joints in your back as the source of that “popping sound” with twisting or with a chiropractic manipulation.

What 3 roles do the facets have?

The spine is a fascinating column and the facets are part of this support structure that serves the very important roles of support, motion and protection (of the spinal cord and nerves).

If you look at the spine from the side, there is a front, middle and posterior or rear portion or column of the spine that all serve different functions. The anterior column of the spine is comprised of the bony vertebrae and discs. It is a column of vertebral bodies (vertebrae) that can be likened to building blocks connected by fibro-cartilaginous spacers or discs. These vertebrae have numerous bony projections that serve as places where muscle-tendon-ligament complexes to attach, like the stays of a sailboat attaching to the mast. The middle column is the hollow spinal canal that is tube shaped and contains the sensitive spinal cord and nerves. The posterior column is comprised of the lamina and the spinous processes that act as levers and also protect. The facet joint is where the posterior column and the anterior column connect to each other. The spine can be likened to hollow tube that moves and the facet joints and discs are where that motion occurs.

What are 3 things that restrain motion of the spine?

One consistent theme in the spine is motion. The spine is designed to move in almost any direction, with limits. There are many things that help restrain the motion of the spine. Muscles, tendons and ligaments are the first order of restraint.

The second restraint is the disc. The discs are soft in the center and covered by a very tough covering called the annulus. The annulus is built like a radial tire for strength and has a 360-degree attachment to the vertebral body. The annulus resists rotational motion past a certain point.

The third restraint is the facet joint that is made of two flat bone surfaces connected by a very strong joint capsule that limits motion of flexion and rotation. The facet joint uses the thick capsule and the flat bony surfaces of the facets to accomplish this.

What predisposes the facet joints to hurt as we age?

The pain from facet syndrome is rare in the younger age groups and much more common in people over 65 years old. The reason for this is that the position of the facet joints change as we age.

When we are young, the intervertebral disc spaces (anterior column) are wide and hold the facet joints in a perfect centered position. As we age, the discs start to lose their water content and a slow progressive collapse occurs over the years. This is referred to as degenerative disc disease.

The collapse of the disc space is accompanied by loss of proper alignment of the facet joints on the posterior column. Over a period of time, the misalignment of the facet joints will cause “wear and tear” changes that can trap or pinch the soft tissues that make up the capsule of the joint. Pain can also be caused by worn joint surfaces.

The other source of pain, that is an indirect cause, is the muscle spasm that occurs when the facet joint slips out of joint (subluxation). When the facet gets out of joint, the back muscles will tighten up and spasm to hold the back in position so no more slippage will occur. When a muscle is in spasm, it doesn’t take too long for the lactic acid to build up and be a second cause of pain.

What position is most likely to cause the facets to hurt?

Leaning back while standing (back extension) is the most likely position to aggravate the pain from inflamed or worn facet joints. This position sort of jams the facets closer together and will aggravate any underlying painful conditions. Leaning forward will usually relieve the pressure in the facet joints.

What 5 treatments can relieve facet syndrome pain?

I think the most common way facet pain is relieved is from a chiropractic manipulation. The forceful push seems to be able to move the facet joint back into a more comfortable position and loosen up the capsular tissues.

Anti-inflammatory medications might be helpful to reduce inflammation of these small joints.

Physical therapy exercises can be helpful to train the back muscles to hold the facet joints in a position of comfort and not be susceptible to painful positions.

Pain management might inject the facet joints with some cortisone to reduce inflammation and pain. This must be done with fluoroscopic x-ray or CT for guidance.