Facet Syndrome

Facet syndrome is a condition where injury to the small joints between the bones in the spine (facet joints) causes back pain. Over rotation (twisting) or arching (extension) of the back may injure the joints or the soft disks between the spinal bones. Such injuries result in excessive motion of the facet joint. This causes the cartilage covering the facet joint to wear down. That places pressure on nerves, as they exit the spinal cord.

SYMPTOMS

  • Chronic dull ache in the low back, that gets worse with over-extension and rotation.

  • Pain in the low back, buttocks, hip, and sometimes leg.

  • Sometimes, stiffness of the low back.

CAUSES

Facet syndrome is often caused by repeated or over rotation, over-extension, or extension with rotation of the back. These motions cause injury to the cartilage covering the facet joints. This places pressure on the spinal nerves.

RISK INCREASES WITH:

  • Sports that can cause over-extension of the back, with rotation or repeatedly (golf, football, gymnastics, diving, weight-lifting, dancing, rifle shooting, wrestling, tennis, swimming, volleyball, track and field, rugby, other contact sports).

  • Poor back strength and flexibility.

  • Poor exercise technique.

PREVENTION

  • Learn and use proper technique.

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Back and hamstring flexibility.

  • Back muscle strength and endurance.

  • Cardiovascular fitness.

PROGNOSIS

This condition is often resolved with proper non-surgical treatment.

RELATED COMPLICATIONS

  • Recurring symptoms, resulting in a chronic problem.

  • Delayed healing, especially if sports are resumed too soon.

  • Prolonged impairment.

  • Narrowed canal for the spinal cord, due to bone spurs (bumps) resulting from chronic erosion of the facet joints (spinal stenosis).

TREATMENT

Treatment first involves stopping activities that aggravate your symptoms. Ice and medicines may be used to reduce pain and inflammation. Your caregiver may advise strength and stretching activities, to be completed at home or with a therapist. You may be referred to a physical therapist for further treatment, including: ultrasound, manual adjustments, transcutaneous electronic nerve stimulation (TENS). Surgery is rarely needed. It is reserved for athletes with persistent pain, despite 6 to 12 months of proper non-surgical treatment. Surgery involves joining (fusing) two bones of the spinal column, to stop motion between the facet joint and disk.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities advised by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 to 4 weeks, despite treatment.

  • You develop numbness, weakness, or loss of bladder or bowel function.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)