Do you have a stiff lower back? You could have a lower back joint sprain, also known as lumbar facet syndrome. It can occur quite easily, but when managed properly it can be resolved easily as well. We see this kind of injury every week and get excellent results with physiotherapy treatment. Lower back joint sprains can happen to anyone, active or not. It is mostly associated with turning sports though, and is more prevalent in men than in women. Lumbar facet syndrome has a sudden onset so one minute your back will be fine and the next moment, after a twist or unexpected movement like slipping on a floor, you will have lower back pain on the right or left side.
We are the experts when it comes to treating lower back pain. We thrive on getting you back into action as soon as possible, whether that means playing sport, sitting in front of your computer, gardening or picking up your grandchild.
What is a facet joint and what does it do?
A lower back joint sprain occurs in the facet joints – that’s why it’s also called lumbar facet syndrome. Facet joints are small joints in your spine, one on the left and the other on the right side of the vertebrae. They are synovial joints which mean that they are surrounded by a joint capsule and can glide on top of each other, but only to a certain extent. They are also known as zygapophyseal or Z-joints.
These facet joints work in pairs and function almost like an aeroplane’s wings. If the one of the left goes down, the one on the right must go up and vice versa. In other words, the small joints guide and limit movement. In medical terminology we refer to your neck spinal segments as cervical, middle back segments are called thoracic and in your lower back they are called lumbar.
In this article, we will focus a bit more on the lumbar segments as we will discuss the cause of lower back joint pain.
How does a locked facet joint or sprain occur?
A lumbar sprain can happen quite easily when the joint moves beyond its normal limits. The muscles and ligaments around the facet joint keep it on its “track” where it’s supposed to move. If you move past this limit, there is too much pressure on the facet joint and an overstretch of the capsule around it which leads to a sprain. In extreme cases the facet joint can’t return to its normal position, resulting in a locked facet joint. The injury leads to inflammation of the sprained joint which causes muscle spasm around the area. Unfortunately, this leads to a stiff lower back and extra pressure on the already painful joint.
What causes a lower back joint sprain?
Lumbar facet syndrome usually has a sudden onset when you least expect it. Let’s say you’re sitting in the front seat of your car. Your purse is lying on the back seat and you need to get it. You turn and lean back in your seat while your hips are still facing forwards. During this movement, you feel a sudden, sharp twitch in your back – you’ve sprained a facet joint. Other symptoms include a spasm in the surrounding lower back muscles, so your back can start to feel stiff and uncomfortable.
Similarly, this injury can occur in sports. Golf, tennis and cricket are all sports that involve rotation and/or extension (backwards movement) of your lower back.
Muscles
The muscles around the facet joints are meant to stabilize the facet joint; these muscles are called local stabilizers. If your small stability muscles are not doing their job due to pain, your bigger muscle groups take over their function. However, the big muscles are actually responsible for movement of your lower back. This leads to overuse of the big muscles in your lower back, because they are doing their own job and also helping with stability of your facet joints. Overuse causes muscle spasm, pain and dysfunction and that is why you have a stiff lower back when you have a lumbar sprain.
Hypomobility
(not enough movement)
(not enough movement)
Causes of hypomobility:
- lumbar spondylosis
- bony spurs (degeneration in the bone with outgrowth)
- joint capsule thickening
- protective muscle spasm
Hypermobility
(too much movement)
(too much movement)
Causes of hypermobility:
- trauma
- dislocation
- overstretched ligaments
- Rheumatoid arthritis
Signs and symptoms of a lower back joint sprain:
How bad is my lumbar facet syndrome?
There are a couple of factors that can help you determine how bad your lower back pain is. These include:
Discomfort vs pain
A stiff lower back or discomfort usually means that your injury is less severe than if you have constant, excruciating pain. If you ignore the stiffness and discomfort it could become painful. This means that your problem is getting worse and you need to consult a physiotherapist for an assessment and treatment.
Area
Pain that is localised to a specific part (left or right side) of your lower back is generally less serious than if your whole lower back hurts and if there is pain in your buttock area. If you have lower back symptoms that run all the way down to your lower leg and foot, you might not have a lumbar sprain, especially if you have pins and needles or numbness. Rather call us for an accurate diagnosis.
Ease of movement
Your problem is less severe if you can still complete your daily activities like getting out of bed, walking, getting up from a chair comfortably without too much pain. Once your symptoms start interfering with these daily tasks your problem is more serious. If you wake up at night when turning around in bed or you struggle to get up in the mornings, it’s time to get help.
Range of movement
When lumbar facet syndrome is mild you will notice that certain movements cause a sudden, sharp pain that goes away after a couple of minutes. This usually happens at the end of a movement, like when you reach down to tie your shoes or lean back to get something from the backseat of your car. With a more severe injury even small movements cause this sharp pain and it doesn’t settle down even when you’re sitting or lying down.
Diagnosis
Our physiotherapists treat lower back pain every day, so we are very experienced in diagnosing and treating different kinds of back problems, no matter how severe.
During our assessment we will test the movements of your spine to find out exactly which movements hurt. This gives us an idea of what could be causing your problem. We’ll also test muscle strength, flexibility and stability in order to confirm how severe your injury is, which will dictate your treatment plan.
When we evaluate a lumbar sprain, we will also do a neurological screening to rule out any nerve involvement. Different structures can cause left or right side lower back pain and if we find weakness or numbness in your legs with this screening it may indicate that you have a lumbar disc injury or another nerve injury.
After we’ve done all of our movement tests we will also do a hands-on assessment to pinpoint the exact cause of your problem. This is the part of our evaluation when we put pressure on different segments and parts of your spine so that we can find out which level and structure is injured.
Sonar
(Diagnostic Ultrasound)
(Diagnostic Ultrasound)
If we suspect a locked facet, an ultrasound won’t give us the necessary information as it only picks up pathology in the soft tissue. It may indicate a muscle spasm or a thickened ligament in that area, but in this case a sonar will be unnecessary.
X-rays
X-rays can give us an indication of lumbar spondylosis or degeneration, but can’t confirm a diagnosis of lumbar facet syndrome.
Therefore, it is not necessary to get an x-ray done before you have seen your physio.
MRI/CT scans
An MRI is useful if we suspect a lumbar disc injury or nerve involvement, but an MRI is costly, especially if there isn’t any suspected serious pathology. It is unnecessary for lumbar facet sprains.
Why is my lumbar sprain not going away?
Many people think lumbar facet syndrome or a stiff lower back will just go away on its own. Especially if it comes and goes. However, your stiff lower back or the right/left lower back pain you experience, every couple of weeks, is a sign of a deeper problem.
Lumbar facet syndrome is usually caused by degeneration of the facet joints and/or dysfunction of the small stabilising muscles in the area. Without treatment this dysfunction will only get worse over time. You will notice that it happens more often and takes longer to go away until you decide to just live with the daily discomfort. Eventually small movements like picking up your grandchild or getting groceries out of your car will cause severe lower back pain for days, or weeks.
Physiotherapy treatment involves restoring the movement of your facet joints and correcting the dysfunction of the muscles in and around your lower back. We can teach you to manage your problem and give you a better option than just ignoring the pain and discomfort.
What NOT to do
What you should do
Making the injury worse
A big problem we see with lumbar facet syndrome
Ignoring the problem
One of the biggest problems we see with lumbar facet syndrome is that patients wait until they have constant lower back pain or an episode of pain every week or two. A stiff lower back is often the first warning sign before a lumbar sprain. If you ignore the stiffness, discomfort and episodic pain your body will try to solve the problem on its own. This usually means that the bigger muscles that are responsible for movements have to help to stabilise the painful facet joint. The result will always be muscle spasm and dysfunction of the rest of your lower back, because the tightness in the big muscles interfere with your normal movements.
Medication use
When you have the first episode of lower back pain it will often settle after a couple of days with just pain and anti-inflammatory medication. So naturally, when it happens again, you will turn to medication to solve the problem. As your lumbar facet syndrome gets worse though, there will come a time when medication isn’t enough anymore. You will need to take more medication for a longer period of time before your back feels better. As time goes on you will also notice that your pain comes back more often and stays longer. Medication only treats the symptoms, physiotherapy treatment gets to the root of the problem.
Back braces
Another problem we see with lower back joint pain is that patients become dependent on back braces. A brace can be useful in the acute phase of the injury, but if you use it for too long the muscles around your lower back become weak because the brace is taking over their function. As the saying goes “if you don’t use it, you lose it”.
Physiotherapy Treatment for lower back joint sprain:
The first thing your physiotherapist will do is a detailed assessment to find out what’s causing your symptoms. There are many structures in your lower back that can cause pain, so before we can treat the problem we need to find the problem.
After the assessment we will know which techniques and exercises are appropriate for your lower back injury.
Treatment will include:
Electrotherapy like laser and ultrasound for pain relief and to promote healing of the injured facet joint.
Soft Tissue Treatment like massage and dry needling to help relieve muscle spasm and tightness in your lower back.
Strapping to help with support of the painful area.
Exercise programs to strengthen stabilising muscles in your back, that help to protect your facet joints.
Education about your condition and teaching you what to do and what to avoid doing.
Remember, your physiotherapist only sees you for an hour, the rest of the 24 hours are up to you. Your physio will tell you exactly what to do during those hours.
Phases of rehabilitation
1st Phase: Protection and initial pain management
The first phase of your treatment will involve lots of information about your condition. We will explain the treatment plan and give you advice on everyday things to help manage your pain. Like changing your sleeping position or your posture when you’re sitting at your desk.
During this phase of treatment we will use joint mobilisations and myofascial release to treat the back stiffness. Electrotherapy like ultrasound and laser will also help with pain relief at this stage. We also use strapping or taping to help support and protect the area while we start with gentle, pain free exercises.
Our goal is to get you moving again!
2nd Phase: Establish pain free range of movement
At this stage of the rehabilitation of your lumbar facet syndrome, your range of movement will still be limited due to pain. During this second phase we will find the part of your movements where you can move without symptoms and start with exercises in this range. Getting you moving early on is important when treating a lower back joint sprain, but it’s even more important that the movement is guided by your pain and discomfort. We will also continue soft tissue treatment and electrotherapy during this phase.
3rd Phase: Activating stabilising muscles
Once we have established where you can move without pain, we will start with specific exercises to activate the stabilising muscles in your spine. These small muscles control movement between the segments of your lower back, thereby protecting the facet joints and discs from excessive movement. We need to restore their function before we can start with the big movements like bending and reaching.
4th Phase: Motor control and stability
When we move, each muscle and joint, in our body has a specific job that needs to be done at specific times. For instance, when you want to take a step, the small stabilising muscles in your lower back should stabilise your lower back to prevent excessive movement. Only then do the big muscles work to lift your leg and as that leg lifts, the stabilising muscles around the other hip should keep your pelvis from tilting. This is what we call motor control and all this normally happens quickly and without thinking.
However, with a stiff lower back or a lumbar facet strain, the small stabilising muscles don’t function the way they should, so the whole sequence breaks down. During the previous phase we activated these small muscles to restore their function, now we add bigger movements to make sure they can stabilise your lower back in all directions. We do this by adding exercises that train rotation (turning) movements, flexion (bending forwards) and extension (leaning backwards).
After completing this phase you should be able to control all these movements without too much concentration.
5th Phase: Adding functional load
6th Phase: Muscle strength
By now you should be able to walk, sit and get in and out of your car with ease. The goal of this phase is increasing muscle strength to get rid of the stiffness in your lower back and limit episodes of your lumbar facet syndrome.
We do this by adding elastic resistance or weights to your exercises. Depending on what you were doing before the injury or your goals for the future, like hiking or scuba diving, we will progress the resistance until your spine can not only tolerate everyday activities, but also allows you to try new things without flare-ups.
7th Phase: Testing for return to activity
This last phase of rehabilitation is arguably the most important part. Your physiotherapist will retest the movements that caused your symptoms in your initial assessment. We also do tests to stress the facet joints and ligaments in your lower back to “clear” the joint. This means that the facet joint moves the way it should, the stabilising muscles can control the movements of your lower back in all directions, the big muscles are strong enough for daily activities like picking up groceries or moving furniture and the muscle length is restored so that you can reach and stretch without symptoms.
How long does a lumbar joint sprain take to heal?
Acute lower back pain
With an acute lumbar sprain your injury will follow the course of normal tissue healing, so the first order of business is to get your pain under control. In the first week or two of treatment we will see you twice a week to treat pain and start with rehabilitation, in other words get you moving without pain again. Thereafter we will see you once a week to continue with soft tissue treatment and joint mobilisation, but mostly to continue with your rehabilitation. This involves adapting your exercises as your back’s ability to tolerate movement and load improves. Once you are back to all your normal daily activities without pain or discomfort we will see you every second week to check on your progress and increase the intensity of your exercises. After that we will see you again after about a month to “clear” your back, in other words to put stress on the facet joints in your lower back to make sure there isn’t any residual stiffness or weakness.
Chronic lower back pain
Lumbar facet syndrome is often related to degeneration of the joints and discs in your lower back, in which case we cannot reverse or heal the damage. However, we can make a huge difference to your pain and get you back to doing the things you enjoy. Our treatment plan and how often we need to see you will depend on the severity of your condition and your current pain.
If you have constant lower back pain we will see you twice a week until your pain is under control. Thereafter we will make an appointment once a week to maintain the joint movement we have gained and to increase the intensity of your exercises. As your exercises get progressively harder the time between treatments will increase to two weeks and later a month to check on your progress and adapt your exercises as necessary. You could have a flare-up sometime during the course of treatment if there is a sudden increase in your activity, but this will settle down after one or two treatments, because you have already started the rehabilitation process. Short term discomfort are sometimes necessary for long term gains.
What happens without treatment?
Without physiotherapy treatment or if you don’t finish your rehabilitation, the pain and stiffness will always return and get worse over time. At some point you will find that you have constant discomfort and or pain that isn’t relieved by rest. Working with your physiotherapist you can make sure that this doesn’t happen.
Other medical treatments for a stiff lower back
- Back brace – Using a back brace for a couple of days could help with pain relief by taking pressure off the injured facet joint, but it won’t solve the problem or prevent recurrence.
- GP – Your doctor can prescribe pain medication and muscle relaxants to help with pain relief. However, this only treats the symptoms, so at some stage your pain will come back.
- Biokineticist – After finishing physiotherapy treatment to restore movement and muscle control in the painful area, seeing a biokineticist can be helpful for strengthening and long-term management of your problem.
- Orthotics – If you have other underlying problems like a leg length discrepancy or overpronation of you feet orthotics can help with management of your condition.
- Chiropractic – An adjustment by a skilled chiropractor can resolve a locked facet joint, but that still won’t get rid of the underlying problem that caused the joint injury in the first place.
- Crutches – It can be helpful to walk with crutches for a couple of days if you have severe pain when walking.
Surgery for lumbar facet syndrome
If your lumbar facet syndrome doesn’t improve with non-surgical treatment in 3 months there are some surgical options available. However, these techniques are not always effective, so it is very important to find a knowledgeable surgeon who can discuss all options with you.
- Lumbar facet joint injections – the surgeon injects cortisone into the facet joint.
- Lumbar fusion and decompression – if the cause of your lumbar facet syndrome is severe degeneration of the discs and facet joints in your lower back, a lumbar fusion may be necessary. The surgeon fuses two or more segments of your lower back together during this procedure.
- Lumbar facet joint nerve block – this involves injecting local anaesthetic at the level of the painful facet joint.
- Continuous radiofrequency thermocoagulation – this technique uses heat to destroy the small nerves going to the facet joint that contribute to your pain.
- CT-guided kryorhizotomy – the surgeon uses computerized tomography (CT scan) to guide a cold probe that destroys the small nerves around the facet joint.
Also known as
- Lumbar facet syndrome
- Lower back pain on the left/right
- Stiff lower back
- Lower back joint pain
- Lumbar sprain
- Locked facet joint
What else could be causing your stiff lower back?
- Lumbar spondylosis – the stiffness you feel with this condition gets better with movement.
- Lumbar compression fracture – any movement of your lower back will be painful, lying down will give you some relief.
- Alignment disorders like scoliosis – you will notice that one shoulder or hip is higher than the other side.
- Infection – if you have a spinal infection you will have other symptoms like fever and general body aches.
- Lumbar disc injuries – your pain will get worse with sitting or bending down, like putting on shoes.
- Lumbar spondylolisthesis – extension (backwards movement) of your back will make your pain worse and pain will be more in the middle of the lower back, not the left/right.
- Piriformis syndrome – symptoms are mostly in the buttock and leg, you may notice pins & needles or numbness in your leg.
- Lower back muscle spasm – you will have stiffness and pain over your whole lower back that gets better when you stretch.
