Facet joints are a part of the vertebrae that connect
the vertebrae above and below. The facet
joints, which are a pair on either side of the spine and the central discs are
the joints which connect the vertebrae and they are designed to support the body
weight, control and enable free movement of the vertebrae of the spine.
Each facet joint has smooth cartilage which surrounds
the bony body of the vertebrae and ensures cushioning between the two surfaces
and also strong connective tissue wraps round the bony ends of the vertebrae
providing support to the whole spine.
A facet joint sprain can occur when there is an excessive
force placed on the joint and the surrounding connective tissue may tear or the
cartilage maybe damaged. This could be
from a particular trauma, i.e. excessive lifting and twisting, or bending or
could be from a build up of poor posture over a long period of time causing excessive
wear and tear of the cartilage.
Facet joints sprains are a common cause of back pain
and are most common in the cervical vertebrae of the neck, or the lower back’s
lumbar vertebrae.
If cartilage is damaged and/or there is a connective
tissue tear, inflammation is the body’s first reaction and the surrounding
muscles will tightening and can spasm as they work hard to protect the back,
just like in an ankle sprain! This is
the body’s natural response to prevent you from incurring more damage. Plus, owing to the inflammation and tightness sometimes
nerve impingements can occur and often muscles either lower or higher than the
point of injury compensate and work hard to control our movements and hence these
then can become tight and tense from overuse.
Generally a facet joint sprain will reveal itself as
pain particularly on one side of the spine, a feeling of being uneven,
lopsided, increased pain on bending sideways, bending your head to the side or
sliding your arm down the side of you leg.
Generally pain and stiffness is worse first thing in the morning.
If you suspect you have tweaked, sprained your facet
joints, then the first thing to do (as with any soft tissue damage) is to
control the inflammation with NSAIDS (nonsteroidal anti-inflammatory drugs) and
pain relief. Inflammation is the body’s
first stage of healing. For a facet
joint sprain it is the cartilage and surrounding connective tissues (muscles,
tendons, ligaments, fascia) that need to heal and a normal tissue healing
process is approx. 4 – 6 weeks, depending on the severity of the injury. So resting and not straining the area is key,
but movement needs to be maintained, facet joints like to move and often the
pain is worse first thing in the morning, or after long periods of sitting, so
keeping moving is key. Light walking is
essential.
The great news, facet joints sprains do heal and Remedial
Massage Therapy can help support the healing process once the initial “acute
stage” of healing has passed, which is generally the first 3 – 5 days where
inflammation is dominant.
To follow is an overview of how Remedial Massage
Therapy supports the healing process:
1 - in the early days post injury the focus of
Massage is more on the surrounding soft tissue, rather than the injury site
itself. This is to prevent joint
stiffness that can occur because of muscle tightness and/or weakness and to
promote the development and mobility of scar tissue. As mentioned earlier facet joints like
movement. The benefits too are increased
circulation, keeping blood, nutrient and oxygen flow to the area for the best
chance of healing.
2 – as the healing progresses Massage will focus more
on the injury site with caution and with a light touch so as not to increase
any discomfort. Movement of the limb/body
area is necessary to maintain mobility and circulation. The focus is on preventing muscle
compensatory patterns and overuse stresses elsewhere in the body occurring. The healing process involves the body laying
down scar tissue to “knit” together the connective tissue and it is essential
at this stage to encourage the movement of the scar tissue to help the
realignment of the scar tissue fibres in the direction of the required forces
for optimal movement. A mixture of hot
and cold therapy at home is encouraged too.
3 – in the later stages of healing deeper tissue
massage to the areas above and below the injured area is key to further support
healing, addressing any tension from compensatory patterns, for example this
might be in the mid back, the gluteus muscles (the bottom) and the hamstrings
in the case of a lumbar facet strain. Also
with a lumbar sprain often the pelvis can be pulled out of alignment, because
of the muscle guarding and tension. Plus
there is a continued focus on the injury site, using a gradual build up of
pressure, to minimize scar tissue adhesions and to continue to optimize movement.
It is worth noting that the healing time for soft
tissue damage varies from person to person and depending on the type and
severity of an injury.
Advice to the client at home is to keep moving and to
strengthen the deep core muscles, to adopt safe bending and lifting and be
aware of how your posture effects your body.
There are stretching and strengthening exercises that can be performed
at all stages of healing, which can be discussed. Seeking rehabilitation advice from a
Physiotherapist may also be relevant.
Please note,
this article is intended as an overview of facet joint sprains, an explanation
to the possible cause of low back pain. If you have any more specific questions let me know, nicky@nickysportsmassage.co.uk.