Lumbar facet joint pain syndrome is a mouthful for a easily treatable back pain. Lower back symptoms caused by lumbar facet joints emerge from to the chemical inflammation of the facet joint capsule. Lumbar facet syndrome accounts for 15 – 41% of chronic lower back pain, whether it’s the primary or secondary cause of lower back pain its very common and fixable. The crushing of the joint surfaces in the small joints of your back from new back exercises, long periods of standing, and repetitive turning activities leads to various problems inside your lumbar facet joints. Physiotherapy is a great treatment for lumbar facet joint syndrome, let’s dive deeper into the components of the problem, and how to fix it.

The lower back has five lumbar vertebrae, counted from the transition of the last thoracic, T12, vertebrae L1 – L5. The vertebral bodies have discs in between them. The rest of the vertebrae’s structure, the lamina, transverse and spinous processes, fit together snugly, like lego pieces stacked on top of each other to create a tower. These “snug fits” are the facet joints or zygapophyseal joints. You have one on each side of a vertebra, where the one on the top slides on the one below. This forms four facet joints per vertebra or 12 articulations.

The lumbar facet joints are angled at 45 degrees to the frontal plane and parallel to the sagittal plane. This allows forward, backwards and turning movements like bending down to put on your shoes, bending back to reach overhead or twisting to look behind you.

Nothing works in isolation. The facet joints work intimately with the fibrocartilaginous joints between each vertebra and disc. This is a very close-knit space for all the important structures that are protected by the vertebrae. Nerve roots exit the neural foramina to supply the body of messages and receive messages in return.

You need sufficient stability from your core muscles, including your diaphragm and pelvic floor to sustain a healthy pressure system for your lower back. Healthy muscle tone and the ability to switch on during movement patterns are crucial to have an even distribution of force through the different structures. Ultimately you need all the members of the team to pull their weight.

In isolation, your lumbar facet joints are like the brake pedal when you bend backwards. When you reach the end of your available range of motion you can feel a “bony block” when the facet joints are in close contact.

Acute lumbar facet joint syndrome can happen due to a sudden increase in training or new exercises or movements that you are unaccustomed to. Like when suddenly playing a golf tournament or increasing the weight on your single-leg deadlifts or holding your baby, who slowly but surely gains weight and gets heavier. When the facet joints are loaded in their end range position the joint capsule can become inflamed leading to a dull ache or a sharp pinch when you go into the position. You may feel relief by “opening the joint” by twisting away from the pain full side or bending forward. With quick intervention, this should be resolved within 2 – 3 weeks. If you get stuck in the cycle of resting and taking medication and then going back to training, chronic changes can happen.

Chronic lumbar facet joint syndrome leads to erosion of the joint surface, like a key that doesn’t turn smoothly in a lock. This causes inflammation in the joint which in turn can lead to the thickening of the joint capsule and ligaments. This may show up on your X-rays as facet joint hypertrophy. The bone may respond by creating bony spurs or osteophytes in an attempt to generate stability. This can increase subchondral bone volume but decrease mineral content.

Facet joint syndrome may also be the by-product of spondylosis. As we age we naturally lose disc height, causing the vertebrae to move closer together. This causes the facet joints to load bear much sooner in movement and can cause a decrease in rotation and extension movement availability, making you feel more rigid and less mobile.

• Poor posture, like hyperlordosis or sway back
• Spondylosis or normal age related changes
• Manual labour and heavy lifting
• Overweight and obesity
• Traumatic injuries, like falls, with resulting spondylolysis
• Overuse injuries, like throwing sports or swimming, especially butterfly
• Hypermobility with emphasis on end range back bends, like ballet, yoga and acrobats
• Congenital abnormalities in vertebrae shape
• Scoliosis
• Inflammatory conditions like ankylosing spondylitis and rheumatoid arthritis

A first incident of acute lumbar facet joint pain causes intermittent pain with very specific movements. The symptoms may not even stop you from training. It is mostly restricted to the affected facet joints and can therefore be very specific in location and smaller area. Swelling is a given, but it is most likely not visible. The tight fit and confined space between the facet joints expands to press on the surrounding structures. A weird jerk or pull on your back triggers the initial phase, and if not attended to it struggles to return back into it’s original state.

Repeated incidents of lumbar facet joint injury and even unresolved acute injuries sets in motion a cycle of trauma, without recovery. Like a wound on the sole of your foot, but you continue jogging – it’s got no hope of healing. When your pain starts to radiate up or down, you must intervene. A spillover to nearby joints above and below starts showing signs of overexertion due to compensation. When the dull ache is there at rest or with very small movements like getting up from a chair the condition is getting worse not better. Our main concern with repeated injuries is that you begin to avoid movements because of fear of hurting yourself again, we can fix fear avoidance. This hesitation can you stop attending specific functions or training sessions just to avoid the expected lower back pain.

Lumbar facet degeneration is the culmination of these repeated episodes of injury, rest, reinjury, avoidance and not addressing what contributes to the problem. Repeated inflammation causes the joint capsule, ligaments and bones to change in response and thicken – restricting movement even more. This is visible on X-rays. The more of the structure or the bigger the bone becomes the less available space to allow movement. A constant tight and stiff feeling in your back. Lumbar facet hypertrophy rarely happens in isolation, most likely the disc space has narrowed, the neural foramina are stenosed and osteophytes are also visible. With this stage of pathology, we aim to slow down the degeneration, but we cannot change what has already happened.

We understand structural integrity and how this translates to functionality. Our physiotherapists are experts in anatomy, have clinical experience and expertise to test and identify the cause of your symptoms. We understand the implications of your problem and can offer you guidance and structure for your recovery.

By knowing what is causing your pain you can be pro active in your decisions. Getting the right diagnosis is crucial to avoid premature lumbar facet degeneration.

We will also test other structures like, discs, nerves and muscles in the area, to ensure a comprehensive diagnosis. That’s why our physiotherapists are the best at diagnosing lumbar facet syndrome. Even though your primary diagnosis is something completely different, we’ll identify the the priority and hierarchy that needs to be treated.

X-rays shows all bony elements of your spine. The alignment and integrity is visible and we are able to see if there is joint hypertrophy, disc space narrowing or osteophytes. 89% of people between the ages of 60 – 69 have facet joint osteoarthritis visible on imaging, but not all have symptoms.

Your physiotherapist can refer you to get x-rays taken if necessary.

Diagnostic ultrasound is not of value with the diagnosis of lumbar facet joint syndrome.

An MRI scan shows the integrity of all of the structures in your lower back, including muscle, ligaments, discs, nerves and bones. For facet joint syndrome diagnosis MRI is excessive. If your physiotherapist suspects anything more than just the facet joint, you will be referred to the right specialist.

Your posture or movement habits are to blame for symptoms that keeps reoccurring. This may cause a cycle of pain where you stop doing upward facing dog in your vinyasa yoga class for two weeks, feel great and then go jam your back right back into symptoms the next time you go into the pose. Or your bowling or throwing practice. Get it checked out so that you can change the habits that contribute to your symptoms. This may include learning something new about your body, strengthening exercises, avoiding little cheats you have (hypermobile athletes especially) and ultimately making sure that this is the last incident of your lumbar facet joint syndrome.

Excessive and recurring incidents of lower back facet joint pain will ultimately lead to facet joint hypertrophy or spondylolisthesis.

Manipulation is NEVER the first line of treatment for lumbar facet joint syndrome. Manipulation describes a forceful end of range movement. An uncontrolled manipulation may cause more damage than good if all the structures were not tested. You may think though a forceful “shakedown” or “click” of your back will get your spine “back in alignment” and therefore take your pain away. This is not the case. The risk of more damage is much grater than potential relief, and not even healing.

Waiting too long and hoping the pain will go away is not the answer. If you don’t use it, you lose it. Muscle strength, length and joint range of motion needs to be worked on and maintained. Recovery time is directly linked to how long you’ve had the pain.

Bedrest is an outdated approach to back pain and won’t make your healing time shorter. Active recovery is the chosen line of treatment to get you back to what you love to do.

The same is true of wearing a back brace for a prolonged period of time.

Medication provides symptom relief and nothing more. Find the structure causing your symptoms through a clinical assessment, consider any contributing factors and address the root cause of your symptoms to prevent the problem from recurring.

Our physiotherapists have years of experience in recognising symptom patterns and finding why you developed lumbar facet syndrome in the first place. We know anatomy and understand how biomechanics influence local structures but also the repercussions certain movements can have on other structures further away. Our aim is to help you understand your problem and empower you to prevent this from happening again in the future.

We pride ourselves in our work and offer the best treatment for lumbar facet joint syndrome by providing guidance and answers and implementing an effective and structured plan of action. Movement is medicine, we want you to feel confident in the dosage you take. We will also look at muscle strength, joint range of motion, flexibility, ligament stability & nerve control.

You will need physiotherapy treatment twice a week for the first two weeks for symptom management. After this, your treatment sessions is spaced out to allow for regaining movement and implementing your home exercise program. How fast you recover will greatly be up to you. Every case is unique and healing times may differ. You can expect 3 – 6 weeks to feel better and move comfortably with another four weeks of rehabilitation to ensure that this doesn’t happen again.

• Your doctor (GP) will prescribe anti inflammatories and analgesic medication to ease symptoms.
• A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.
• Wearing a back brace when you have to stand for long periods of time can be considered, but limited to a maximum of four weeks.
• Stretching or foam-rolling might ease your symptoms temporarily, but will not address the root cause of your pain.
• Your back is not out of alignment, subluxations or dislocations are extremely painful results of traumatic injury.
• Inversion tables may ease your symptoms temporarily, but there is no magic bullet that requires you to do nothing. Anything worthwhile takes effort and commitment.

Surgery is the last resort when all attempts at non-surgical pain relief and rehabilitation was unsuccessful. Remember that with any surgical intervention, there are risks involved. We are not cars that drive off once a mechanical part has been replaced, rehabilitation after surgical intervention is crucial and may take up to six weeks to completely recover with an additional six weeks to get you back to training.

Lumbar facet joint blocks are a minimally invasive, temporary procedure.  A combination of anti-inflammatories and analgesic medication is injected straight into the facet joints involved. Now you have the window of opportunity to change the muscle imbalances that contributed to your pain in the first place.

Facetectomy can be done to trim away any excess bone spurs or osteophytes which may cause restriction of the movement segment, this may lead to instability in the long run or contribute to degenerative disc disease.

Lumbar fusion surgery will be considered if you have instability from a traumatic injury, like a fracture or spondylolisthesis or if the stenosis is severe enough to cause nerve root compression. This surgical intervention requires a six week period of keeping your back straight, lying down or standing, from where the hard work to get you back moving freely really starts. You may lose range of motion with this procedure.

• Lower back muscle spasm

You still have your full mobility, although you may feel stiff.

• Discogenic lower back pain

Symptoms may be accompanied by referral into your hip or leg and aggravated by bending forward.

• Spondylolisthesis

Instability is the most common symptom, especially with small, sudden movements accompanied by sudden and sharp pain, like turning in bed or returning from a bent-over position.

• Sacroiliitis

Stiffness and pain over the tailbone with decreased movement of the hip joints.

• Sciatica

Pain is predominately felt in the back of the hip and leg and worse when bending forward.

• Degeneration of lumbar facet joints
• Lumbar facet joint pain
• Lower back facet joint pain
• Lumbar spondylosis