Innovative Lumbar Facet Syndrome Treatments

What is Lumbar Facet Syndrome?

“Lumbar facet syndrome” describes acute or chronic inflammation of a joint in the lumbar spine. The facet joint is thought to be the source of pain in 15-45% of patients with chronic low back pain. The literature is mottled with various explanations for the onset of facet syndrome, including previous sprain, joint tightness, cysts and/or joint degeneration

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The lumbar facet joints are motion-restricting joints meaning they are oriented in specific directions in different parts of the spine to guide movement either in the forward to backward plane or in the side to side, rotary plane. The upper segments of the lumbar spine limit rotation, while the lumbar facet joints in lumbar facet syndrome resist forward to backward movement. These facet joints are highly innervated by nerves which can be hypersensitized by an inflammatory process, ultimately causing pain.

Repetitive joint stress or other cumulative low-level trauma is the most common origin of facet pain. Excessive compression and extension (back bending) of the lumbar spine causes more demand and loading on the joints than they often have the capacity for. This can lead to inflammation and joint dysfunction, including adhesions within the joint with subsequent potential for degenerative changes of the joint. Fortunately, treatments like Facet Joint Syndrome Treatment are available to offer relief from this debilitating condition.

What Will Lumbar Facet Syndrome Look and Feel Like?

Painful stimulation of the facet joint has been shown to cause back and/or leg pain. Not surprisingly, the most frequent complaint associated with facet syndrome is lower back pain radiating toward the side body, hip, and/or the thigh. While chronic referral to the thigh is likely, true radiating complaints down the leg suggest an alternate diagnosis. Facet pain generally presents on one side of the low back with peak intensity over the affected joint. A complaint of stiffness or morning stiffness may be associated with degenerative change of the facet joint. Symptoms of facet pain may present following an acute injury but are more commonly the result of cumulative micro trauma.

A 1988 study identified seven factors associated with the diagnosis of facet joint pain: an older patient (over 65), with recurrent low back pain, radiating symptoms no further down the leg than the knee, which is exacerbated with extension (back bending) from a fully flexed position. The good news is that relief is within reach with various options available for Facet Joint Syndrome Treatment. Typically, one will find relief in a seated or reclined position. Predisposing factors for the development of lumbar facet syndrome include a history of trauma, overuse, osteoarthritis, systemic joint inflammation, and being overweight.

Typically, one would demonstrate localized tenderness to palpation over the facet joint. Muscle guarding may emerge as a protective response, making surrounding muscles in the area tight and tender. This can be in the low back area or even extend down into the glutes and hip flexors. This tightness is often seen in combination with weakness in the muscles of the back side of the body including the extensor muscles along the spine as well as the glutes.

How Do We Treat Lumbar Facet Syndrome?

Treatment progresses from pain relief to restored mobility and eventually functional stabilization and strengthening. There is significant data to suggest that spinal manipulation (SMT) is an effective treatment for lumbar facet syndrome. Spinal manipulation is helpful to break up joint adhesions, which helps to re-establish “normal” function and mobility.

Research has demonstrated that manipulation for lumbar facet syndrome is superior to no treatment options and best done in conjunction with other medical management including physical therapy, mobilization, exercise, acupuncture, and massage.

Interventions will address restrictions in the thoracic, lumbar, sacroiliac, and pelvic regions for those seeking facet joint syndrome treatment. It will be important to address the functional instability around the spine with strengthening. Improving stabilization around the spine can reduce pain, restore normal motion and mobility and allow an individual to return to prior level of function.

Myofascial release techniques may be appropriate for lumbar facet syndrome, especially for adhesions in the muscles of the lower back, hip flexors, hip rotators, gluteals, hamstrings and quadriceps. These techniques in addition to flexibility exercises may be an added to a home program in order to facilitate improved posture and a neutral spine position as this will be important for a patient to be able to assume during strengthening and stability exercises.

Patients with lumbar facet syndrome may need to limit heavy physical activity but should avoid bed rest. Lifestyle modifications should include removal of the pain-inducing activity. Patients will be counseled on lifting mechanics, work activities, sleep positions, and show wear. Educational counseling regarding predictable exacerbating activities for lumbar, lumbosacral, and hip trigger points is warranted. This may include minimization of prolonged sitting and sedentary hobbies. Yoga has been shown to be an effective treatment for simple mechanical low back pain. Some NSAIDs may help reduce pain and inflammation initially, however, Acetaminophen has proven ineffective for acute LBP. It is important to explore other options such as facet joint syndrome treatment to find relief from low back pain  - consult with your doctor if you are considering taking medication.

The evidence supporting corticosteroid injections into the joint for lumbar facet syndrome is limited: hence, this should be reserved for those individuals who do not respond to consistent, conservative treatment. Mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) may be effective in managing facet syndrome, however there is not enough evidence to be conclusive one way or the other.

If you are suffering from low back pain or symptoms consistent with lumbar facet syndrome, call us or click below to make an appointment to see how our doctors can help.