Your Guide to Lower Back (Lumbar) Facet Joint Injuries

Introduction

A facet joint injury of the back is probably one of the most common injuries we see at Central Physio and Performance Fitness. This type of injury is very common among people who spend a lot of time in front of computers, people who are required to bend forward a lot, and those that have to do some form of heavy lifting in their day. This can be a very painful injury but with proper treatment this injury can be fully corrected.

Anatomy

The lumbar spine is formed by the lower 5 spinal vertebrae, named L1 to L5. There are two facet joints between each pair of vertebrae, one on each side of the spine. The surfaces of the facet joints are covered by articular cartilage. Articular cartilage is a smooth, rubbery material that covers the ends of most joints. It helps absorb shock and allows the bone ends to move against each other smoothly, without pain.

Symptoms

Lumbar facet injuries often occur suddenly with bending or back jarring mechanisms. Patients often experience a sudden sharp pain in the lower back – usually more localised to one side. It is usually both painful and difficult to move in certain directions, and the pain tends to catch with quick movements.

What Happens If I Don`t Fully Fix My Back?

Persisting pain and restriction in movement will continue if a facet joint injury is left untreated. A lot of the time facet joint injuries cause the surrounding back muscles to go into spasm. If this is left untreated, continuing muscle tightness will persist, leading to further increases in pain and restriction in movement. People with facet joint injuries also commonly alter their posture to help with the pain. This increases the likelihood of other structures being damaged as the changes in posture result in pressure being transmitted to other areas of the body that are not strong enough to handle it.

How Long Does It Take To Get Fully Better?

Patients can begin to notice improvements in as little as 1 treatment session, however results will vary depending on the severity of the injury. Patients can generally expect to have significantly
reduced pain and full range of movement 7-14 days after commencing physio treatment.

It is important to note that to ensure full recovery and reduce the risk of future problems, it is vital that you correct background problems of muscle tightness and weakness. Your physio will check these and guide you through effective exercises that are able to correct them. Depending on your history this crucial part of your treatment will usually take 6-12 weeks.

Phase 1: Restore Range of Motion

The first step in your recovery from a facet joint injury is to restore your back’s normal range of motion. Restoring your full movement is essential to ensure you are able to successfully and safely get back to your normal activities.

Techniques your physio may use to help restore movement include joint mobilisations, soft tissue releases and massage to relieve muscle spasm. You will also be guided through an initial specific exercise program to help you recover as fast as possible..

Phase 2: Restore Muscle Length

In response to a facet joint injury the muscles around your back tighten up. The muscles recognise there is an injury to the facet joint and begin to work harder to protect the joint from being damaged any further. In working harder than normal these muscles tighten up and make movement of the back increasingly difficult.

Techniques your physio may use to improve muscle length include soft tissue massage, specific stretching and flexibility exercises, and heat. Your home program will advance to stronger mobility exercises as your symptoms settle.

Phase 3: Correct Biomechanics

Facet joint injuries of the back are often caused by poor biomechanics (how you move) in your normal activities, eg. at your workplace or during sport. This may be due to muscle tightness or weakness, poor workplace set-up or exercise technique. Correction of these is vital to provide you with a lasting recovery.

Your physio will check for undesirable movement patterns and provide effective strategies to correct them. This may include strengthening, stretching, or correction of workplace ergonomics or sports technique.

Phase 4: Re-educate Movement Patterns

Your body often changes the way it moves to compensate for the pain produced by a facet joint
injury. These ‘new’ postures can become habitual and can be difficult to change. This can lead to loading of other weaker structures not normally used to handling stress. This increases the risk of injury to other areas of your back and to other parts of your body.

Techniques your physio may use to help you reeducate your movement patterns include core stability exercises, stretching, and postural control exercises. Your physio may use video feedback or a mirror for these exercises to allow you to see how you should be moving and help you to consistently perform them correctly at home.

Phase 5: Re-Stabilise

This is one of the most important steps to ensuring full recovery from a cervical disc bulge. Restabilising means re-training the muscles in your body that help to keep your spine strong and stable. Research has shown that your stabiliser muscles are the first muscles to switch off when you get back pain. If these muscles switch off and are not properly re-trained they lose their conditioning, become smaller and weaker, and your chance of a full recovery is limited. By re-stabilising your spine you are able to move more efficiently and the risk of re-injury is greatly reduced.

Techniques your physio may use to help re-stabilise your spine include Clinical Pilates, Exercise Physiology, light functional strengthening, swiss-ball exercises, deep neck flexor muscle retraining and exercise to build you core strength.

Phase 6: Sports/Ballistics and Advanced Strengthening

Once you are familiar with the exercises required to restabilise your spine your physio will then progress you to more advanced exercises specifically aimed at your activity or sport of interest. For muscle strengthening to be effective the muscles need to be strengthened in the specific way to how they will be used during your daily activities. This phase involves building your spinal strength to comfortably handle the heavier loading and fatiguing demands of sport and exercise.

Many clients find that seeing one of our Exercise Physiologists, Strength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your spinal strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.

For more information or to speak with one of our physio’s to discuss your symptoms please call us on 9280 2322 or contact the clinic.

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