by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
The facet joint consists of two opposing bony surfaces with cartilage between them and a capsule around it. The joint also has fluid lubricating the joint.. Facet arthritis occurs because of the wearing away of cartilage between the facet joints. When the joints move, the lack of the cartilage causes pain as well as restricted motion and stiffness.
The spine consists of a stack of vertebrae that interact with each other. In front, the vertebrae are separated from each other by rubbery discs. In back the vertebrae are separated from each other by facet joints. The joints combine with the disc space to create a three point complex at each vertebral level.
As the facet joint becomes more arthritic, it enlarges leading to irritation of nearby nerve roots. This situation causes muscle spasm and pain.
Facet arthritis is most common in the low back and neck where more movement happens.
Typically, the back pain is most pronounced first thing in the morning. Throughout the day, normal movement causes a “loosening up” in the joint and there is usually less pain. Later in the day the pain typically becomes worse again as more stress is applied across the joint.
Conservative treatments aimed at maintaining motion in the back are most effective for relieving the pain.
•Stretching exercises for the hamstring muscles, hip joints, and the back can usually prevent the pain from getting worse.
•For more severe pain, chiropractic or osteopathic manipulations can help relieve pain.
•Water therapy can be also be helpful since the joints are subject to less weight in the water and do not generate as much pain when being moved.
•Acetaminophen is a non-prescription medication that sometimes helps alleviate the pain, and some patients find non-steroidal anti-inflammatory drugs (NSAIDs) to be helpful.
•Physical therapy modalities such as ultrasound, traction, and electrical stimulation are useful.
•Facet block injections consisting of specially guided injections into the facet joint can also be of value
Facet rhizotomy- cutting the nerves that supply sensation to the facet joint- can be done either surgically or through a procedure called radiofrequency ablation.
The only effective surgical treatment option is a fusion to stop the motion at the painful joint, but this surgery is generally not recommended since multiple vertebral levels tend to be affected by osteoarthritis and multilevel fusions are generally not effective.
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