Chiropractic Treatment for Facet Joint Pains
Spinal manipulation alongside exercise are two of the most effective treatments for both acute and chronic facet joint pain. Manipulation releases both the facet joints and the deep muscle spasms close to the facet joint. Alongside Chiropractic treatment, other treatments and exercises are indicated:
- In the acute phase, an ice pack can be helpful to decrease the inflammation.
- Resting the back – some lying down with your knees raised to help reduce the pressure on the facet joints.
- Varying your activity while avoiding movements that are painful.
Chronic long-term strains are more involved. If wear and tear – degeneration – is present, with disc height reduction, the facet joints can take more strain and load, increasing the stress and possibility of injury. Recurrent episodes of facet joint pain can indicate ‘functional instability’ with more scar tissue or fibrous adhesions. In some cases with severe degeneration, the condition may need more long-term management.
Change in lifestyle is usually required, with less sitting, more variation of activities such as using a sit-stand desk, losing weight, and less driving.
Correct exercise long-term will be extremely important for facet joint stability. Equally important is advice on how to move and sit, for which Alexander Technique can be excellent.
Cervical Facet Joint Injury
Cervical or neck facet joint injury can cause neck pain and headaches, and also cause pain radiating into the arms and upper spine. The cervical facet joints have a rich supply of overlying nerves that innervate the deep neck muscles, which can cause pain. Spasm at the C2-C3 joint is supplied by the third occipital nerve, a cause of headaches.
Causes of cervical facet joint injury
The cervical facet joint is susceptible to trauma caused by a fast movement strain of the head backwards in extension, side bending, and rotation, such as in an acceleration-deceleration injuries like a whiplash injury in an RTA (Road Traffic Accident). The joint capsule or the meniscoid body can be trapped by the facet joint.
Another common complaint from clients is that they “just woke up with the pain” after holding the head in an awkward position for an extended period: sleeping in an uncomfortable position, lying on the sofa watching TV or using a laptop or tablet. The head can be in a side-bent and rotated position, possibly with a “locked” antalgic neck and unilateral neck pain.
Examination of neck facet strain
Because of the impingement and muscle guarding, movement is painful and clients experience decreased movement with contralateral side bending and rotation. There is sharp tenderness on touch or palpation of the affected facet joint.
Chiropractic treatment for cervical or neck facet sprain
Ice is usually correct, especially if there is intense pain or swelling. In the acute phase, the objective is to reduce the muscle spasm to help restore movement and decrease pain:
- Deep massage or trigger point treatment with some gentle traction can release the muscular spasm.
- Various different contract-relax release exercises of the cervical muscles can be very beneficial
- Chiropractic adjustment to the cervical spine is also very effective when the severe muscle spasm has decreased and the patient can tolerate the movement. With experience, it is possible to tell when the manipulation can be performed.
- Clients often experience fairly quick improvement in the acute cases, particularly when there has been no major traumatic onset.
- With severe injuries such as car accidents, Chiropractic treatment is best given as soon as possible. This can help tremendously to speed recovery and prevent long-term postural changes, bad adaptive movement patterns and chronic muscle spasm.
Medical Diagnosis and Treatment of Facet Pain
Facet joint injection diagnosis
Facet joint injections can be performed in the cervical, thoracic or lumbar regions, and are considered by some in the medical profession as the gold standard in diagnostic evaluation.
In 1976 research, saline solution injections to healthy facet joints created radiating pain into the buttocks and posterior thigh. Following studies showed this pain could be relieved by intra-articular injections, demonstrating the facet joints are a clear cause of back pain. Saline solution injections into the cervical facet joints can cause pain in the arms or upper back and can ‘map’ specific referral pain patterns.
Medical treatments for facet joint injuries
- Physiotherapy will usually involve strengthening exercise, which can sometimes be helpful, but can also aggravate the condition if done excessively or incorrectly.
- The Chiropractic approach I use is quite different and more hands-on.
- Sometimes, acupuncture is used.
- Non-steroidal anti-inflammatory (NSAIDs) drugs are commonly given, but are shown to reduce healing so should be used minimally, if at all.
- Steroid joint injections to the facet joint.
- Anaesthetic nerve to block pain.
- Surgery: If all other conservative treatments fail, operations that fuse the joints may be an option.
Overall, a variety of treatment approaches is helpful.
Imaging diagnosis of lumbar facet pain
- X-rays don’t diagnose facet pain, only advanced degeneration or osteoarthritis and other spine conditions, like scoliosis or spondylolisthesis.
- Computed tomography (CT) scan.
- Magnetic resonance imaging (MRI) scan.
- Diagnostic blocks – where medicine is injected into the facet joint nerves near the joint and a 50% reduction in pain indicates the facet joint is involved.
Todd R. Hooks PT, SCS, ATC, MOMT, MTC, CSCS, FAAOMPT, in Physical Rehabilitation of the Injured Athlete (Fourth Edition), 2012