With neck or back pain, people automatically assume that the spinal discs are the source of pain. Sometimes that assumption is incorrect because frequently the small joints of the spine called the facet joints are the culprit. This very common generator of cervical, thorocic and lumbar pain connects one boney segment to the other, helping to form the entire spinal chain or column like a big long Slinky. These joints are extremely important for supporting motion such as twisting, bending and turning. Without these facet joints, the spine would feel like one big broomstick. Because the spine is constantly in motion, the joints are always being stressed and can become worn out, swollen and painful.
Arthritis in the facet joints is technically called Facet Arthropathy. You’ll find that term on radiologists’ reports examining the spine by X-Ray, MR, or CT imaging. Facet arthropathy can be seen in those who do not have any pain and in those as young as their 20s. In reality, these joints become arthritic as the spine degenerates. First the disc starts to degenerate, and then the joints start to degenerate. Degeneration of the spine is as inevitable as aging of the skin and taxes. Skin wrinkles do not hurt and most of the time spine degeneration does not hurt either (taxes are a different story). But occasionally facet arthropathy does hurt.
Some very interesting experiments were done years ago to map out the places where facet pain is felt at various levels of the spine. Yes, facet joint pain does travel. For example, the lumbar facets in the lower back (L4-5 and L5-S1) are very common sources of pain. This pain is usually felt in the buttocks and down the back of the thigh, similar to sciatica. In the cervical spine, the facets at the base of the neck often refer pain to the shoulder blade region. In addition to knowing these referred pain patterns, it is also important to note that pain in the facet joint is often provoked in positions that place increased stress on the joint like standing, lying on the stomach, looking overhead and twisting. Finally, facet arthropathy is often associated with spinal stenosis which can cause pain in the nerves that go down the arms or down the legs. Because facet arthropathy can cause widespread pain and nerve pain, more people should take care of these tiny sources of major pain.
Caring for the facet joints is part of a good spine health program. Avoiding activities that repetitively involve twisting can really help prevent facet arthropathy pain. Those who golf might need to cut back to playing just nine holes and not playing daily. Avoid prolonged periods of times looking overhead. Someone who is painting a ceiling might need to break that activity up over multiple days. Improving spine posture can have profound impact on the facet joints. Abdominal wall strength is extremely important for facet joint health. For the joints in the neck, one should keep the chin from drifting forward and up just by tucking the chin just a little bit toward the chest while keeping the chest out. Improved posture can greatly diminish stress on the cervical facet joints. With proper care over a lifetime, the facet joints can last a lifetime. And until we have better spine replacement technology, these joints need to last.
In fact, severe end-stage arthritis in the facet joints is very difficult to treat. They are so small and so numerous; even the ever popular radiofrequency ablation procedures can only temporarily interrupt the pain. And sometimes these temporary results are not worth the expense and risks. A surgical solution is not much better. Spinal surgery in the form of a spinal fusion can stabilize the situation at the cost of motion. So, facet joint preservation is the best option to prevent facet arthropathy from becoming a debilitating condition. Be kind to your spine and it will be kind to you.
Specialist in Pain Management and Spine Rehabilitation