On the Mend
Joe diVincenzo
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The occasional sore back is generally nothing to worry about, but if you've been having frequent episodes of sharp pain, it could be an indication that you have a problem with one of your lumbar facet joints.
A facet joint is a small portion of the vertebrae that helps to guide the motion of your lumbar spine. They are critical to maintain the health and safety of your low back, but undergo considerable degeneration in your after the age of forty or so if you've had any low back trauma.
Each facet joint is separated by a thin layer of tissue called a meniscoid. Meniscoids are extremely sensitive to compression and inflammation, and when damaged, can radiate into and around the lumbar spine.
Meniscoids function similarly to a meniscus in the knee. They help to absorb shock and encourage smooth motion of both joint partners. If a meniscoid is pinched, it will cause stabbing pain that could freeze you in your tracks.
If a facet wears down, you could end up with bone-on-bone contact, accelerating the aging process of the spine, eventually leading to arthritis.
The hallmark feature of a facet problem is typically the inability to bend the trunk backwards. Facets can be sore without movement, however, and often are the source of a dull, nagging pain in the low back. If you've ever been sore on a rainy day, an inflamed facet could be the reason.
Facets can also refer pain into the buttocks and upper thigh. Pain that extends past the knee is generally not considered as having originated from a faulty facet joint.
Clinically, facet pain is fairly easy to diagnose and similarly easy to treat. Clinicians have a broad variety of manual techniques available to arrest pain and restore normal range of motion.
Lumbar manipulation, sometimes called a lumbar adjustment - causes a quick separation of the painful facet joint, alleviating the compressed tissue. Often, a case of a single stuck facet joint can be resolved with one treatment session.
Joint mobilization is a less aggressive yet effective technique used by manual medicine clinicians world-wide. Similar to a manipulation but performed at a slower speed, joint mobilization may be the best form of treatment for patients who aren't candidates for manipulative or adjustment therapy.
Although exercise and stretching can play a critical role in mitigating back pain, it is the least aggressive and usually the slowest way to achieve resolution facet issues. Patients who are not candidates for higher-energy therapies can still have good outcomes using specific exercises tailored to their individual needs and may benefit from consulting with an exercise specialist once the diagnosis of facet pain has been made.
Most people will experience a stuck facet at some point or another over the course of a lifetime. Fortunately, these problems tend to resolve on their own without formal treatment, but if your pain lasts any longer than a few weeks, get checked out before it becomes a chronic problem.
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Gloucester resident Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes "On the Mend" weekly. Questions may be submitted to Joe by email joedivincenzo@comcast.net.
