Wednesday, 15 July 2015

Back pain? Could your back pain be a sprain of the facet joints of the vertebrae? Read on for an explanation….

Facet joints are a part of the vertebrae that connect the vertebrae above and below.  The facet joints, which are a pair on either side of the spine and the central discs are the joints which connect the vertebrae and they are designed to support the body weight, control and enable free movement of the vertebrae of the spine. 

Each facet joint has smooth cartilage which surrounds the bony body of the vertebrae and ensures cushioning between the two surfaces and also strong connective tissue wraps round the bony ends of the vertebrae providing support to the whole spine.

A facet joint sprain can occur when there is an excessive force placed on the joint and the surrounding connective tissue may tear or the cartilage maybe damaged.  This could be from a particular trauma, i.e. excessive lifting and twisting, or bending or could be from a build up of poor posture over a long period of time causing excessive wear and tear of the cartilage.

Facet joints sprains are a common cause of back pain and are most common in the cervical vertebrae of the neck, or the lower back’s lumbar vertebrae. 

If cartilage is damaged and/or there is a connective tissue tear, inflammation is the body’s first reaction and the surrounding muscles will tightening and can spasm as they work hard to protect the back, just like in an ankle sprain!  This is the body’s natural response to prevent you from incurring more damage.  Plus, owing to the inflammation and tightness sometimes nerve impingements can occur and often muscles either lower or higher than the point of injury compensate and work hard to control our movements and hence these then can become tight and tense from overuse.

Generally a facet joint sprain will reveal itself as pain particularly on one side of the spine, a feeling of being uneven, lopsided, increased pain on bending sideways, bending your head to the side or sliding your arm down the side of you leg.  Generally pain and stiffness is worse first thing in the morning.

If you suspect you have tweaked, sprained your facet joints, then the first thing to do (as with any soft tissue damage) is to control the inflammation with NSAIDS (nonsteroidal anti-inflammatory drugs) and pain relief.  Inflammation is the body’s first stage of healing.  For a facet joint sprain it is the cartilage and surrounding connective tissues (muscles, tendons, ligaments, fascia) that need to heal and a normal tissue healing process is approx. 4 – 6 weeks, depending on the severity of the injury.  So resting and not straining the area is key, but movement needs to be maintained, facet joints like to move and often the pain is worse first thing in the morning, or after long periods of sitting, so keeping moving is key.  Light walking is essential.

The great news, facet joints sprains do heal and Remedial Massage Therapy can help support the healing process once the initial “acute stage” of healing has passed, which is generally the first 3 – 5 days where inflammation is dominant. 

To follow is an overview of how Remedial Massage Therapy supports the healing process:

1 - in the early days post injury the focus of Massage is more on the surrounding soft tissue, rather than the injury site itself.  This is to prevent joint stiffness that can occur because of muscle tightness and/or weakness and to promote the development and mobility of scar tissue.  As mentioned earlier facet joints like movement.  The benefits too are increased circulation, keeping blood, nutrient and oxygen flow to the area for the best chance of healing.

2 – as the healing progresses Massage will focus more on the injury site with caution and with a light touch so as not to increase any discomfort.  Movement of the limb/body area is necessary to maintain mobility and circulation.  The focus is on preventing muscle compensatory patterns and overuse stresses elsewhere in the body occurring.  The healing process involves the body laying down scar tissue to “knit” together the connective tissue and it is essential at this stage to encourage the movement of the scar tissue to help the realignment of the scar tissue fibres in the direction of the required forces for optimal movement.  A mixture of hot and cold therapy at home is encouraged too.

3 – in the later stages of healing deeper tissue massage to the areas above and below the injured area is key to further support healing, addressing any tension from compensatory patterns, for example this might be in the mid back, the gluteus muscles (the bottom) and the hamstrings in the case of a lumbar facet strain.  Also with a lumbar sprain often the pelvis can be pulled out of alignment, because of the muscle guarding and tension.  Plus there is a continued focus on the injury site, using a gradual build up of pressure, to minimize scar tissue adhesions and to continue to optimize movement. 

It is worth noting that the healing time for soft tissue damage varies from person to person and depending on the type and severity of an injury.

Advice to the client at home is to keep moving and to strengthen the deep core muscles, to adopt safe bending and lifting and be aware of how your posture effects your body.  There are stretching and strengthening exercises that can be performed at all stages of healing, which can be discussed.  Seeking rehabilitation advice from a Physiotherapist may also be relevant.

Please note, this article is intended as an overview of facet joint sprains, an explanation to the possible cause of low back pain.  If you have any more specific questions let me know,