What is Facet Joint Injury?
In order to understand a Facet Joint Injury, it is vital to known what a facet joint is and what are its functions. The facet joints are present in the spine and their function is to protect the spine from getting displaced from their normal position or getting twisted due to any motion that an individual makes.1 It also protects the spine from having excessive motion, which may create problems for the spine. This is precisely the reason why a Facet Joint Injury impacts the spine greatly. The facet joints allow twisting and motion of back and neck and thus, any Facet Joint Injury impacts severely these types of motions.
Another important function of the facet joints is to protect a condition called spondylolisthesis, in which one vertebra comes on top of another vertebra causing significant pain and other associated symptoms like limited mobility.2 A Facet Joint Injury can be abrupt such as when struck by a great force such as in a motor vehicle collision or being shot in the back or hit by a heavy object.
Facet Joint Injury can also develop gradually due to natural wear and tear of the cartilage and tendons of the spine and the bones become arthritic. Due to this, there is development of bone spurs which further may cause pain and disability for the individual. When this gradual development of Facet Joint Injury occurs then it is said that there is arthritis in the joints. The spine which is most predisposed to such Facet Joint Injury is the lumbar and the cervical spine. A Facet Joint Injury may also result in the spinal nerve getting blocked at its exit point from the spine.
Facet Joint Injury at multiple levels of the spine results in what is called as Facet Joint Syndrome. Due to a Facet Joint Injury, there is development of spasms of the muscles adjacent to the injured facet joints resulting in the neck or the back losing their postures and there may also be tilting of the neck to one side and there the back may have a crooked appearance.
Physical therapy and chiropractic care is the best way to treat Facet Joint Injury. Facet Joint Injury caused due to a motor vehicle crash or any other injury to the spine may cause the facets to break away from each other. It may also injure the cartilages causing pain and inflammation.
What Causes Facet Joint Injury?
As stated, Facet Joint Injury can be caused due to a direct blow or trauma to the spinal cord as a result of a high impact collision. Sporting injuries like being tackled in a football game may also result in a Facet Joint Injury. In the elderly population, a Facet Joint Injury can occur due to wear and tear of the cartilage and overall degeneration of the spine creating pain and inflammation and inability to move the joint normally. This is what is called as arthritic pain.
What are the Symptoms of Facet Joint Injury?
It is important to note here that Facet Joint Injury occurs only in the cervical and lumbar spines and hence the symptoms of Facet Joint Injury are limited to only the neck and the back. Some of the symptoms of Facet Joint Injury are:
- Sudden onset of neck or back pain, which may worsen with a twisting or turning activity.
- Tenderness at the site of the inflammation in the neck or back area along with decreased mobility of the neck or back depending on which facet joint is injured.
- In cases of Facet Joint Injury in the lumbar spine, the back pain will worsen when leaning backwards and better with leaning forward
- For Facet Joint Injury in the lumbar spine, the pain will begin at the low back and radiate down the buttocks to the back of the thigh. In very rare cases, it may radiate down to the legs.
- In cases of cervical Facet Joint Injury, the pain will begin at the neck and radiate down the shoulders into the forearm. In very rare cases, the pain may radiate down to the wrist and fingers.
- The pain arising from Facet Joint Injury is unpredictable and there is no precise timing for the pain. The pain may get worse with driving or walking for prolonged periods of time due to muscle spasms that occurs as the muscle fatigues and wears out due to sitting or walking for prolonged periods of time.
How is Facet Joint Injury Diagnosed?
To begin with, a detailed history of the patient is taken in which the physician especially inquires as to a history of any injury or accidents recently or in the past affecting the lumbar or cervical spine. A physical examination of the affected area is then conducted, which in cases of Facet Joint Injury will reveal tenderness in the affected area and restricted range of motion. The physician will also inquire as to whether the patient is experiencing any pain radiating down the extremities whether it be the neck or the back.
Once a Facet Joint Injury is suspected, radiological studies in the form of an x-ray, CT or MRI scan will be obtained which will clearly show decreased joint space or in some cases separation of the facet joints, thus confirming the diagnosis of a Facet Joint Injury. A facet joint block is perhaps the best test to diagnose a Facet Joint Injury.
If a Facet Joint Injury is suspected, the physician will inject a steroid like hydrocortisone along with a contrast dye and a local anesthetic at the affected area. If there is complete pain relief after the injection then the diagnosis is confirmed of a Facet Joint Injury.
How is Facet Joint Injury Treated?
The front line treatment for Facet Joint Injury is conservative, although in rare cases surgery may be recommended. Physical and chiropractic therapy is the best way possible to treat Facet Joint Injury. Aggressive strengthening of the back and neck is done to prevent any wearing out of the muscles or muscle spasms causing pain. The patient is taught how to maintain a good posture.
The patient will also be taught on the different ways to drive a car like pulling the car seat in front a bit to prevent any undue pressure on the lumbar spine or if standing for prolonged periods of time putting one leg up on a things like pulling the car seat forward when driving or put one foot up on a ridge or something elevated may do wonders in cases of a Facet Joint Injury.
Applying heat to the affected area is also quite effective in treating Facet Joint Injury. An individual can apply heating pad to the affected area for 15 to 20 minutes two to three times a day until the pain improves or completely goes away while the facet joint heals.
The patient is also recommended to avoid prolonged driving or walking for long periods of time till the symptoms go away and the facet joint is healed and comes back into position.
The patient will also be prescribed NSAIDs in the form of ibuprofen or Tylenol to control pain and inflammation. Another variety of medications called the Cox II inhibitors like Celebrex are also quite effective in treatment of Facet Joint Injury. Apart from all this, chiropractic manipulation also plays an important role by bringing the facet joint in proper alignment and thus treating Facet Joint Injury.
For Facet Joint Injury in the cervical spine a cervical collar may be prescribed to restrict the range of motion of the neck until the time the symptoms subside and the injury is healed. Botox injections are also sometimes used for treatment of Facet Joint Injury, as this will treat the muscle spasms caused due to Facet Joint Injury.
What is the Recovery Time for Facet Joint Injury?
The recovery time from a Facet Joint Injury is variable and differs from individual to individual. This totally depends on the how diligent the patient is during physical and chiropractic therapy and the activity modifications that has been recommended to the patient. For a person compliant with treatment protocols, it may take around three weeks to get completely treated from a Facet Joint Injury whereas in an individual who is not so compliant it may take a lot longer to get completely treated from a Facet Joint Injury.