Lumbar Facet Joint Sprain
What is it?
The spine comprises of many vertebrae. Each vertebra connects with the vertebra above and below by three joints: two facet joints on either side of the spine and the discs centrally. These joints support body weight and enable spinal movement.
Each facet joint has cartilage which lies between the joint surfaces, which cushions the impact of one bone on another. Strong connective tissue also wraps around the bony ends to provide support.
During certain movements of the spine, stretching or compressive forces are placed on the facet joint. If these forces are excessive and beyond what the facet joint can withstand, there is a risk of injury to the joint. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. This condition is known as a facet joint sprain.Facet joint sprains typically occur during excessive bending, lifting or twisting movements. They may occur from a single trauma or due to repetitive or prolonged forces.
What are the signs and symptoms?
- Sudden onset of back pain during the causative activity, and/or
- Pain and stiffness after the provocative activity, particularly the next morning.
- Symptoms are typically felt on one side of the spine
- Muscle spasm may be experienced around the affected joint
- Pain may be referred into the buttocks or lower limb on the affected side.
- Symptoms are usually made worse by twisting, lifting, arching backwards, bending forwards or sideways or sitting for prolonged periods of time.
How is it diagnosed?
A thorough subjective and objective examination from a chiropractor is usually sufficient to diagnose a lumbar facet joint sprain. Further investigations such as MRI scans or Ultrasounds can be helpful in assisting diagnosis.
How is it treated?
Most patients with a facet joint sprain heal quickly and have a full recovery with an appropriate treatment program. One of the main components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free, allowing the body to begin the healing process without risking further tissue damage. Once this is achieved a gradual return to these activities is possible provided there is no worsening of symptoms. It is also important to perform early movement and strength exercises to prevent stiffness and weakness from developing and to ensure the back is functioning correctly.
As a rule, sitting for prolonged periods should be avoided. However, if inevitable, optimal sitting posture is important to minimize stress on the facet joint. If you sit slouched, your lower back goes into its maximal bend (similar to standing and touching your toes) this may aggravate a facet joint. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your bottom in the back of the chair and a pillow/rolled up towel for lumbar support in the small of your back. Your shoulders should be back and your chin should be tucked in slightly
What is the prognosis?
The recovery time for a facet joint sprain will vary from patient to patient depending on compliance and the body's capacity to heal. With ideal treatment, patients may be pain free in as little as a few days, although typically this can be expected to take 2 – 3 weeks. However, injured tissue takes approximately six weeks to restore the majority of its strength in ideal healing conditions. Care must therefore be taken when returning to activity during this period.
What factors contribute to its development?
• poor posture
• lumbar spine stiffness
• poor core stability
• muscle weakness or tightness
• inappropriate lifting technique
• being overweight
• a lifestyle involving large amounts of sitting, bending or lifting
What treatments are involved?
Chiropractic therapy for a facet joint sprain can quicken healing and may involve: soft tissue massage, postural taping, bracing, mobilization, the use of a lumbar roll for sitting, education, activity modification advice, biomechanical correction, ergonomic advice, clinical Pilates, and exercises to improve flexibility, strength, posture and core stability.
What other interventions are there?
Despite treatment, a small percentage of facet joint sprains fail to improve and may require other intervention. This may include pharmaceutical intervention, investigations such as an X-ray, CT scan or MRI, or assessment from a specialist. A corticosteroid injection into the facet joint may sometimes be used to help alleviate symptoms. The treating practitioner can advise on appropriate management and can refer to the appropriate medical authority if it is necessary.