Bryan Christie

Injury Tip Sheet: Facet Syndrome

Learn what you need to know to help treat and prevent this common back injury.

Kath Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• Occurs most often in the neck or the lower back
• Most common in individuals over 50 years old
• Along with the elbow and knee joints, facet joints are also known as synovial joints

What you need to know

What is facet syndrome?

• Facet joints connect the vertebrae to each other; there is one facet joint on either side of each vertebrae
• Facets joints, like other joints in the body, enable the spine to bend and move and provide support and stability to the spine
• The facet joints are partly made of cartilage to help the spine bend and move smoothly
• When these joints have been injured or extended too far they can become irritated, causing facet joint syndrome

Signs & symptoms

• Difficulty  turning the head or low back without moving the whole body
• Pain and stiffness, typically in the neck or lower back, and difficulty standing up from a seated position
• If the affected facets are in the neck, this can cause not only pain in the neck but can also result in headaches
• If the affected facets are in the lower back, pain can worsen with extension activity and the back can radiate down into the buttocks and legs

When should I see a doctor or other professional?

• You should see a doctor if the pain and stiffness prevents you from your daily activity
• Only doctors can formally diagnosis facet joint syndrome as diagnoses are made clinically through an appropriate exam.  (Diagnoses are confirmed with an anesthetic/steroid injection at certain facet joints.)

Causes

• Whiplash or sudden trauma that causes extreme extension of the spine
• Repetitive extension activities such as performing a pitch in fast pitch softball
• Research suggests that a common cause of facet syndrome is simply degeneration of the facet joint  over time
• Poor posture or injuries that pinch the nerves near the base of the joints

Risk factors

• Gymnasts or other athletes who spend a lot of time in extension are at risk for facet syndrome
• People with arthritis are more susceptible to increased inflammation and pain
• Older people or people with rapid degeneration conditions are especially at risk for worn cartilage and bone spurs

What you can do

Prevention

• Ensure that you keep your back as strong and flexible as possible.  Strong muscles support the joints and can help protect the vertebrae
• Maintain proper and upright posture
• Avoid an overload of pressure on the joints: maintain a healthy weight and a diet that supports bone strength

Recommendations for treatment and rehab

• Treatment for facet joint syndrome includes avoiding the activity that is causing the irritation
• Avoid extension activities
• Over the counter anti-inflammatory medications (if appropriate) are used to reduce pain
• Physical therapy is often prescribed to regain movement in the joints
• In cases that do not improve with more conservative management (i.e. anti-inflammatory medications, ice or heat, and physical therapy) facet injections with a combination of an anesthetic and steroid are performed under fluoroscopic guidance by a trained physician.  If this does not provide long term improvement then a procedure called radio frequency rhizotomy is performed.  Essentially this procedure ‘de-nerves’ the facet joints and can help reduce pain for up to 18 months

What can I do to stay active?

• Participate in activities that do not reproduce or increase the pain
• If the facet in the neck is irritated avoid activities such as head side-to-side turning in swimming.  Modify activities to avoid irritating the neck i.e. the use of a snorkel and mask
• In the low back, activities that load the spine such as running may need to be decreased, avoid extension-type activity, and typically non-impact activities are tolerated well

Related posts:

• Injury Tip Sheet: Back Sprains and Strains
• Injury Tip Sheet: HNP
• Injury Tip Sheet: IT Band Syndrome
• Battle of the Back Injuries
• Injury Tip Sheet: Annular Tears