Facet Joint Pain

Facet Joint Pain

• The facet joints act like hinges. It is a dynamic structure and does not lock
• There is a lot of debate about whether facet joints can cause pain
• The best treatment is to stay active. There is little evidence to say that facet joint injections work 

Where are the facet joints?
At the back of each vertebra - the circular bones that are piled on top of each other to make up your backbone - there are two facet joints, one either side of the spine, with two vital tasks.

• Allowing the spine the ability to bend and twist
• Giving the spine stability

When the spine is working well, 20-25% of our body weight rests on the facet joints. This can go up to 70% if discs between vertebrae deteriorate.

What is a facet joint?
Although a lot smaller, each facet joint is similar to other joints in your body, like your knees and elbows. The surface of each joint is coated with a thin layer of smooth and tough material known as cartilage. A capsule that produces and is filled with the body's lubricant called synovial fluid surrounds the entire joint. ( You may hear your doctor call facet joints, synovial joints.) The synovial fluid acts like grease on a hinge, helping to ensure that the joint moves freely, reducing friction. It also, nourishes the cartilage. 

Is the pain in my back due to problems in my facet joints?
For the huge majority of people - up to 85% of cases - it is unclear what causes their back pain. Although doctors know that wear and tear goes on in the facet joints there is still a lot of argument about whether these problems are actually a source of pain or not.
Facet joints are almost always in motion. What seems certain is that problems in facet joints can contribute to pain, but - unless there is something seriously wrong - we should not become too obsessed by them. 

What can go wrong?
General wear and tear:
as we get older body is slower to heal. In the facet joints, particularly if the cartilage lining the joints wears thin, new bone growth develops. Not only can this make the joints stiff - limiting movement - but the rough surfaces can rub against, nip or compress the nerves.

Muscle pain:
if the facet joints are put out of shape, it can put added pressure on the muscles around it, causing them to spasm.

Spondylolisthesis:
Occasionally, in about 3% of cases of back pain seen by GPs, one vertebra slips forward because of a weakness in the facet joint, either because of wear and tear or because the joint never developed properly.There are different grades of slip and that in minor cases, there may be no symptoms etc.

Treatments
Unless you have a really serious problem, the best way to get over your pain is to treat it like any other form of back pain.
If you have only had it for a short time ( acute) then the best thing you can do is:

• Keep active
• Take non-steroidal anti-inflammatory drugs ( NSAIDs), such as ibuprofen, which reduce pain and inflammation or use paracetamol - take it at full strength. Side effects could take place and if taking them in conjunction with food to limit irritation of stomach and GI tract. 

 If you have had the pain for more than 12 weeks, then the best thing you can do is:

• Do some structured exercises provided for you by a physiotherapist or your doctor.
• Get onto a multidisciplinary treatment programme, including doctors, psychologists and physiotherapists

 There is no clear evidence that other treatments are particularly effective. What is definite is that bed rest is the worst option.

What about facet joint injections?
It used to be suggested, and still is by some US clinics on the internet, that injecting painkillers or steroids into, or near, the facet joint could help. Research shows, however, that these injections are no better than dummy treatments ( placebos). Occasionally, facet joint injections can have serious side effects including:

• Infection
• Bleeding
• Meningitis
• Damage to your nervous system