Facet Joint Syndrome – A Chiropractic Specialty

You may not have heard of facet joints, but they are extremely important to the well-being and function of your musculoskeletal system. Facet joints are special articulations in the spine that  allow one vertebra to move over another. They come in pairs, located in the very back of each vertebral body (except for the very top vertebra – the atlas). Depending upon their orientation, they will influence the plane of movement that each vertebra will typically move through. For  instance:

• In the lumbar spine (lower back), the facet joints are oriented more front-to-back. This allows  these vertebrae to move more easily in flexion/extension – and less in rotation.

• In the thoracic spine (attached to the ribs), the facet joints shift to a more side-to-side orientation, which allows for less flexion/extension and more rotation.

• In the cervical spine (neck), the angle the facet joints assume will vary from level to level. The very uppermost two vertebrae have facet joints that are almost horizontal and a bit dome shaped, allowing for a great freedom of movement in all directions?

The facet joints of the spine belong to a group of joints called synovial joints. These are fluid-filled spaces, with a smooth layer of cartilage covering both joint surfaces. Since the joint  cartilage does not receive direct blood supply, movements of the joints themselves will create a variable pressure gradient that brings nutrients in and out of this enclosed space. This is why you do not want to have vertebral joint restrictions, or subluxations. Without proper movement, the joint surfaces will not receive their proper nutrition, and accelerated aging or degeneration may

result.

The term facet syndrome defines a collection of symptoms associated with these joints when they  get irritated, inflamed and/or arthritic. This term was first used in the 1930’s to describe lower  back pain that was thought to have originated from these joints.1

Since then, researchers have confirmed the facet joints can be a source of pain – as injections of fluid directly into the facet joints can reproduce the patients’ symptoms. On the other hand, by directly injecting an anesthetic into the same joint, the symptoms can be reduced.2

It makes sense that facet joints can become painful because:

• They contain a number of nerve endings inside them. These nerves relay information to the  brain regarding joint position and movement, allowing for proper balance, coordination, and postural alignment. These nerves can become irritated by compression or inflammation, resulting  in pain.

• Facet joints are surrounded by ligaments. Ligaments are connective tissue structures that  provide stabilization, or a limited range of motion, to the joints. However, these ligaments are also innervated and pain-sensitive – so, if a joint is moved too far past its normal range, these ligaments can become sprained (i.e. rolling over on your ankle).

What Causes Facet Joint Syndrome?

Although facet joint pain is not always consistent, typically a person with this condition will

complain of sharp pain in the area of the facet joint, with restricted movement of the spine –specially extension or rotation. The area involved is usually sensitive to the touch, and often you will find muscle tightness and spasm in the immediate area surrounding the joints. Irritation of the   facet joints is common, and can be caused by a number of factors.

Although facet joint syndrome  can be caused by acute trauma (like hyperflexion and hyperextension), the most common cause of  this syndrome is misalignment of the spine. Focal areas of misalignment, called subluxations, will  predispose the facet joint to abnormal stress and strain, which in turn can create inflammation and  irritation. Postural stress and muscle tension can also make it more likely that you will experience facet  joint syndrome.

What Is the Best Treatment for Facet Joint Syndrome?

Chiropractic adjustments are specifically designed to alleviate the pressure and pain caused by  vertebral subluxations. The positive effects of the adjustment are felt immediately when the joint  cavities (pops). This sound is generated by the release of pressure within the joint, and with less  hydrostatic pressure on the intra-articular nerves, the joint is less painful. In addition, with better joint alignment, all the structures that support the joint are alleviated of abnormal stress and  strain, and the patient is able to relax. Of course, if inflammation still exists in and around the joint, other measures are usually required to bring down the sensitivity of the joint (like ice or other anti-inflammatory substances); however the positive effects granted by the chiropractic adjustment are usually more immediate, and more long-lasting than other treatment options. If you think you might be suffering from facet joint syndrome, see your chiropractor!

References and sources:

1. Ghormley RK. Low-back

pain with special reference to

the articular facets, with

presentation of an operative

procedure - JAMA. 1933; 101;

1773-7

2. Mooney V, Robertson J.

The facet syndrome - Clin

Orthop Relat Res. Mar-Apr

1976; (115):149-56.

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