One of the most misunderstood aspects of your spine is something called facet joints. That’s primarily because it’s hard to describe exactly what a facet joint is and where it lives in your backbone, and what facet joints actually do. Today, I’m going to try to clear this up.
In a previous post I talked about your discs, which are flat structures that cushion the round part of your vertebrae in the front of your spine (toward the front of your body). That round part of the bone is called the vertebral body. At the back of each vertebrae, there’s a bumpy part that sticks out. This is called the spinous process. You can actually feel these bumps if you run your hand down your spine. On either side of each spinous process, there are two small joints called facet joints located on the sides of your spine. These joints help your spine bend and twist.
Your facet joints are small; only about a half inch (1.5 cm) wide. They’re covered by a small layer of cartilage and encapsulated by connective tissue. Inside each joint capsule is something called a synovial membrane, which helps to lubricate the joint and keep the cartilage healthy.
While your discs absorb shock and allow your spine to move to an extent, your facets do a similar job, but with some differences. Your discs absorb about 80% of the vertical forces that affect your spine—actions like running, jumping or lifting a heavy weight overhead. Your facet joints take up the other 20% of that task. The primary job of your facet joints is to allow your spinal column to bend and twist and limit how much movement occurs between each vertebra. Essentially, they control the gliding motion and rotation between each bone to prevent you from overextending or over flexing your spine.
So, what could possibly go wrong? Actually, a number of things. Vertebral facet pain often occurs from joint degeneration. Like any other joint, especially those that are weight bearing, wear and tear over time, changes from aging and trauma can lead to inflammation, loss of cartilage and pain. Some of the most common causes of vertebral facet pain include:
- Osteoarthritis, in which aging and years of use cause the cartilage to wear down in the joints. This causes the bones to rub together, which is a painful condition called facet joint arthropathy. Furthermore, as the joints degenerate, painful bone spurs can develop causing narrowing of the joint space.
- Repetitive motions, such as bending, extending, lifting and twisting, over time may strain your facet joints.
- Accidents, injuries and other kinds of trauma can damage the joints and cause inflammation.
- Vertebral fractures, while causing a great deal of pain in the short term, can also cause the facet joints to become misaligned, and can be a source of long-term pain and inflammation.
- Soft tissue injuries, such as a ligament tear or muscle injury can be the source of pain and instability in the facet joints.
- Similar to repetitive motion injuries, bad posture can place uneven stress on your facet joints and entire spine.
- Carrying extra weight can place an inordinate amount of stress on your spine and facet joints, and can be the cause of facet joint pain.
The primary symptom of facet joint problems is pain. The nature of the pain is that it’s often worse with activity, standing for long periods of time or leaning backwards (arching your back). The pain may be dull and achy and felt only in your back, but it can also be sharp, and it can radiate to your pelvis and down your legs. If the affected facet joints are in your upper back or neck, you may also experience headaches. It’s also common for facet joint pain to cause stiffness and limit your range of motion.
Facet joint pain occurs through a couple of mechanisms. When the joints and tissue around the joints become inflamed, it can cause swelling that compresses the nerves nearby, often causing the pain to radiate to other parts of your body. In addition, if the cartilage has become worn down, increased chafing between the bones can cause pain. Over time, degeneration in the facet joint can lead to bony outgrowths, called spurs, which inflame the joint and surrounding tissue.
Treating Facet Joint Pain
Diagnosing facet joint issues isn’t always straightforward and may take some time. Your therapist may start with a physical assessment of your movements to determine which ones cause or aggravate your pain. Your doctor may order imaging tests, such as X-rays, a CT scan or MRI to get a better picture of your facet joints.
Often the first line of conventional treatments is to apply heat or cold to the painful area. Heat may be used to promote circulation in the area and to loosen tight muscles and other soft tissue. In contrast, cold may be a good choice if there’s inflammation or swelling. Also, depending on your symptoms, rest or increased activity may be recommended. Many doctors suggest non-opioid pain medications, and in many cases, physical therapy sessions can help bring relief. For more severe cases, an injection containing a local anesthetic for short term relief combined with longer acting anti-inflammatory steroids may provide pain relief for several weeks to months. Surgery may also be an option in cases where bone spurs are the source of pain, or to disable one or more nerves that are conducting pain signals from affected facet joints.
Before doing any invasive interventions, try acupuncture. Acupuncture can be a very effective option for people who are experiencing back pain due to facet joint issues. Research has documented that acupuncture works to relieve pain by reducing inflammation in the joint and surrounding areas, increasing circulation, relaxing affected muscles and ramping up your body’s own opioid-like neurotransmitters. A number of research studies support the use of acupuncture for the treatment of back pain, including facet joint pain.
Alongside your acupuncture treatment, I often use additional healing modalities, such as microcurrent, shockwave therapy, far infrared heat or cold laser therapy, all of which penetrate deep into your body’s tissues to promote healing at a cellular level.
The bottom line is that facet joint pain can sometimes be hard to diagnose and confusing to understand. However, it’s a kind of back pain that has a number of treatment options to help you become pain-free and get you back to your everyday activities. Acupuncture is one of those options—and it’s drug-free, natural and can work to heal the affected facet joints, not just mask the pain. If you’re experiencing facet joint or any kind of back pain and want to know if acupuncture can help you, reach out to me to discuss your options.
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Dr. Jeda Boughton is a Doctor of Traditional Chinese Medicine and Registered Acupuncturist in Vancouver. She is also a Registered Herbologist and the founder of BodaHealth.
