Facet Joints

The spine is composed of a column of vertebrae and discs that surround and protect the spinal cord and nerve roots. The spinal facet joints are located posteriorly and control the extent of spinal movement. Muscles, ligaments and tendons help provide stability. Discs act as shock absorbers when axial loads are placed on the spine. The nervous system orchestrates movement through the muscles. The facet joints have a rich nerve supply.

Repeated stresses applied to the joints lead to progressive changes that may be classified as osteoarthritis -which is not a disease but rather a result of wear and tear.

Imaging through x-ray, CT and MRI often reveal changes, which include erosion and focal thinning of cartilage, osteophytes (bone spurs), synovial cysts and joint enlargement. These changes occur with equal frequency in patients with back or neck pain as in those who do not have pain. Patients who have normal appearing facet joints can also have pain. Therefore the source of a person’s pain cannot be solely determined by imaging.

Facet joints are susceptible to the same types of injury, inflammation and degenerative processes that affect other synovial joints in the body, which can result in pain. The lumbar facet joints are a recognized source of low back pain and referred leg pain. Facet joint pain reportedly causes 15-40% of chronic low back pain and is also a common source of neck pain following whiplash injury. Facet joint pain is aggravated by extension and standing, as opposed to discogenic pain, which occurs with forward flexion or sitting. Facet joint pain often occurs in episodic, severe exacerbations of pain that can last for days. People with facet joint pain often report collapsing or becoming completely immobilized by their pain. Facet joints are the source of 50% of chronic pain, including for people with whiplash injuries.

In diagnosing the cause of a person’s pain, one should consider the mechanical forces that caused the facet joint to become injured, inflamed or degenerated. Assessing movement patterns, muscle imbalances and patterns of compensation, chiropractors can correct the cause of facet joint pain with non-invasive tools such as manipulation, myofascial release, exercises and advice. With or without surgery, people with pain can find solutions to correct acute and chronic pain caused by facet joints.