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FACET SYNDROME

The human spine is comprised of a three joint complex. The intervertebral disc and adjacent vertebral bodies make up the anterior aspect of each intervertebral segment. Posteriorly, each vertebral segment has two paired facet joints [Figure 1].

Figure 1: Facet Joints

 

The posterior facet joints are just like other joints in your body. They experience repetitive, constant motion, and thus, they can become worn or torn [Figure 2]. They also can become restricted in their movement and/or develop too much movement, which results in pain. The facet joints are shaped and angled differently in the cervical, thoracic and lumbar spine. This allows for all of the available motion within the human spine.

Figure 2: Facet Joints in Motion

Pain that emanates from the facet joints is termed “facet syndrome.” When suffering from facet syndrome, the facet joints become inflamed and may cause pain, soreness and/or stiffness. Cervical facet joint pain can be felt in the areas of the base of the skull, upper back, shoulders, mid-back or neck. Some patients may present with frequent headaches or even ringing in the ears [Figure 3]. Thoracic facet syndrome is less common than cervical and lumbar facet syndrome and is probably related to less motion available at these levels due to the thoracic articulations with the rib cage. Pain experienced in thoracic facet syndrome is likely to be felt locally near the affected segment near the midline [Figure 4]. In the lumbar spine, there is more motion available and forces are higher, thus pain emanating from these joints is quite common. Pain is usually felt directly over the affected joint(s), but may also be felt in the buttocks, hips, groin, and back of the thighs depending on which facet joint is injured [Figure 5].

Figure 3: Cervical Facet Joint Referral Pattern           Figure 4: Thoracic Facet Joint Referral Pattern
                                                   

 

Figure 5: Lumbar Facet Joint Referral Pattern

 

 

 

In many cases, facet syndrome is caused by trauma, such as a whiplash injury of the neck suffered in a motor vehicle accident. Also, degenerative changes in the cervical, thoracic and lumbar spine can lead to abnormal stress and strain that results in an increased load on the facet joints. Finally, abnormal postures can overload spinal tissues, including the facet joints, and cause inflammation and pain in these joints.

Individuals suffering from facet syndrome may feel worse in the morning, due to increased inflammation and stiffness that occurs during sleep. They tend to have stiffness and usually will feel somewhat better after they have been moving around. As the day progresses they tend to be without pain as long as they keep active. However, for those having to work seated all day like working at a computer, they may find they are at a greater risk of pain throughout the day.

Treatment of facet syndrome involves postural correction, soft-tissue treatments and manipulation of the affected facet joints. MASSAGE THERAPY and Chiropractic are most effective when combined. Massage helps relax the musculature around the inflamed joint, makeing it easier for the Chiropractor to manipulate the joint and restore normal mechanics.  Treatment duration and frequency vary among patients, however, if the injury is dealt with earlier rather than later, positive outcome and painrelief is achieved much sooner.