Facet arthropathy is a type of back arthritis that is a common lower back pain cause.
What is Facet Arthropathy?
Anatomically, the facet joints are the ones that connect vertebral bodies to each other, and if they become arthritic, they can cause pain. This is a common cause of back pain. Under normal circumstances, “facet joints are located at the back of the spine and counterbalance the intervertebral discs”. They are in charge of keeping the spine aligned, and they limit motion. However, if they degenerate, or if there is arthritis, the condition is called “facet arthropathy”, which is an abnormality in the facet joints that causes pain. Typically, patients have lower back pain that worsens when standing, bending backward, or twisting. Unlike sciatica or a slipped disc, the pain of facet arthropathy does not radiate down the legs or into the buttocks; it is generally in a particular area of the spine. Patients can have mild facet arthropathy, lumbar facet arthropathy, or bilateral facet arthropathy. Arthritic facet joints could have bone spurs (outgrowths), which start to minimize the space for the nerve roots. This might lead to spinal stenosis, a condition that consists of numbness, pain, and weakness in the legs and buttocks. It is not uncommon for those with facet arthropathy to have other conditions, such as arthritis affecting other areas of the spine, or even degenerative disc disease, which come with aging. Facet arthropathy is generally diagnosed with a CT scan, MRI, or bone scan. To confirm a diagnosis, a doctor might inject a patient’s facet joints with a steroid (to reduce inflammation) mixed with an anesthetic. If the pain is alleviated, facet arthropathy is likely.1
Medical treatment options for facet arthropathy include non-surgical options such as anti-inflammatory medications, physiotherapy, exercises, stretches, and avoiding certain movements. Steroid injections may also be used. Facet joint ablation is a procedure that aims to alleviate pain “by permanently destroying the nerves that supply the facet joints and “feel” the pain of the arthritis”. Electrical probes are made to go into the skin and a current is used to destroy the nerve. Some patients may undergo back surgery, typically when nerve root compression occurs, or when there is the presence of other lumbar spine issues that also need surgery. In fact, during the spinal fusion surgery, “the surgeon removes the facet joints between the levels of the spine that are to be fused together”.2 Another type of surgery is facet rhizotomy, in which the surgeon will “sever one of the nerves going to facet joint”. Typical medications prescribed for patients with this condition, by medical doctors, are NSAIDS, Tylenol, corticosteroids, and muscle relaxants. Doctors may even suggest, before medications or surgery, that patients try to sleep in a different position. For example, a patient may wish to lie on their back with a pillow under the knees or “curl up the sleep”. Later treatments might include traction, strengthening exercises, aerobics, water therapy, or even spinal manipulation.3
Chiropractic for Facet Arthropathy
Chiropractic treatment is an alternative option for patients with facet arthropathy.4 It is also important for patients to have good posture. This means patients should ensure that, while standing, the hips, shoulders, and ears run in a vertical, straight line. When seated, the patient should sit as close as possible to the desk and take frequent breaks to walk or stand. The chin should be tucked in a little, and both shoulders should be back slightly. Spinal manipulation may provide relieve for patients. Some chiropractic treatment options “include instrument adjustments, lumbar roll, toggle drop and motion palpation”. Massage is another type of treatment that can be provided, and “myofascial therapy…reduces muscle tightness”. Chiropractors can also prescribe particular exercises and stretches to help with range of motion, muscle strengthening, and to reduce inflammation.5 Physical therapy and “lumbar stabilization exercises” may also be beneficial.6 A typical patient might present with pain on only one side of the spine. Chiropractors would work, at first, to “release the muscle spasm”. Relief may be achieved in “4-6 treatments”, followed by “core muscle exercises…to create better spinal control and stability” and prevent future injury. Advice on posture and ergonomics is frequently given by chiropractors. Those with a more chronic, rather than acute, facet arthropathy will have a more involved treatment, often with more frequent sessions over a longer period of time. It is important to remember that pain medications carry side effects and surgery carries risk, so conservative treatments, such as chiropractic care, can provide drug-free relief without all of the concerns associated with conventional medical treatments.7 In addition to the earlier chiropractic treatments mentioned, heat wraps (or hot showers) and cold pads might also reduce pain in some patients. Cervical traction could be suggested, and the DC might make additional recommendations about neck pillows for more pain relief.8