Lumbar Facet Syndrome
- Lower back pain originating from the facet (zygapophyseal joint) and/or joint capsule is referred to as Lumbar Facet Syndrome.
- Medical branch of posterior primary rami innervate joint capsule (each joint is innervated from two spinal levels)
- Estimated that 15% – 40% of lower back pain cases originate from the facet joints.
Pain may be due to:
- Sprain of surrounding ligaments / joint capsule
- Synovial fold / meniscoid entrapment
- Degenerative joint disease of the zygapophyseal joint
Facet Joints & joint capsules are innervated by the medial branch of the dorsal nerve root from the segment above. For example, L4-L5 segment is innervated by L3 nerve root. Medial branch also innervates spinalis muscles (transversospinalis), skin of the back (sensory) & ligaments around articular structures.
History, Signs & Symptoms
- Antalgic Posture, patient is laterally bent away from the side of the lesion.
- Typically patients posture is away from the facet in acute phase, resulting in a slight flexion & lateral flexion position
- May notice abnormal pelvic tilt / hip rotation secondary to tight hamstrings
- In chronic cases, a decreased lumbar lordosis is often observed (body’s response to decreased facet loading)
- Dull, Achy Pain – May be sharp during acute episodes
- Local pain – Patient can pinpoint pain
- Scleroderma! referral of pain
- Pain may radiate to buttock & proximal thigh but does not extend bellow knee
- More Pain on Extension than flexion
- Pain increases with movement & extension – due to the proximation of the facet joints
- Possible muscle splinting & guarded motions
- (+) Kemp’s Test – For back pain, NOT radiculopathy
- (+) Tests that cause lumbar spine extension or lateral
- (-) Nerve root tension signs
- Look for postural and/or activity-induced predispositions to extension motions
- No neurological deficits, negative nerve root tension signs
- Consider Meniscoid Entrapment, Discogenic Pain & Lumbar Strain or Sprain as potential differentials or coexisting factors.
- Lumbar facet syndrome response extremely well to osseous manipulation
- May free entrapped meniscoid
- Muscle relaxation reflex may help with symptoms of pain and limited movement
- Standard manual therapy protocol
- Ice and rest
- Lumbar spine traction
- Corsets/brace – neutral to slightly flexed lumbar brace may help unload the facet joints
- Massage therapy, hydrotherapy
- Electrotherapy: TENS, IFC, Ultrasound
- Conditioning and proprioceptive retraining
- Patient education – Avoid postions & activities that cause increased facet loading
- Surgical treatment: chronic cases that fail to respond to conservative care may respond well to facet denervation as a last resort.