(Also known as Facet Joint Pain, Back Sprain, Zygapophyseal Joint Sprain, Sprained Facet Joint, Facet Joint Dysfunction, Apophyseal Joint Sprain)
What is a facet joint sprain?
The spine comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the discs centrally. These joints are designed to support body weight and enable spinal movement.
Each facet joint comprises of smooth cartilage which lies between the bony joint surfaces cushioning the impact of one bone on another. Strong connective tissue also wraps around the bony ends providing support to the joint.
During certain movements of the spine, stretching or compressive forces are placed on the facet joint. If these forces are excessive and beyond what the facet joint can withstand, injury to the facet joint may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. This condition is known as a facet joint sprain.
Causes of a facet joint sprain
Facet joint sprains typically occur during excessive bending, lifting or twisting movements. They may occur traumatically or due to repetitive or prolonged forces.
Signs and symptoms of a facet joint sprain
Patients with a facet joint sprain may experience a sudden onset of back pain during the causative activity. However, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms are typically felt on one side of the spine and muscle spasm may be experienced around the affected joint. Occasionally pain may be referred into the buttocks or lower limb on the affected side. Symptoms are generally exacerbated with activities that involve twisting, lifting, arching backwards, bending forwards or sideways or sitting for prolonged periods of time.
Diagnosis of a facet joint sprain
A thorough subjective and objective examination from a physician is usually sufficient to diagnose a facet joint sprain. Investigations such as an MRI or CT scan may be required to confirm diagnosis.
Treatment for a facet joint sprain
Most patients with this condition heal well with an appropriate physical therapy program. One of the key components of treatment is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free (a back brace may be required). This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Prognosis of a facet joint sprain
Generally, sitting for prolonged periods should be avoided. However, if inevitable, optimal sitting posture is important to minimize stress on the facet joint. If you sit slouched, your lower back goes into its maximal bend (similar to standing and touching your toes) this may aggravate a facet joint. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your bottom in the back of the chair and a lumbar support (or a pillow / rolled up towel) in the small of your back. Your shoulders should be back and your chin should be tucked in slightly.
Patients should follow RICE in the initial phase of injury. RICE is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). RICE for a sprained facet joint primarily involves resting from aggravating activities (this may include the use of a protective brace) and regular icing. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
Patients with this condition should perform early movement and strength exercises to prevent stiffness and weakness from developing and to ensure the facet joint is functioning correctly. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.
The recovery time for a facet joint sprain may vary from patient to patient depending on compliance with physical therapy. With ideal treatment, patients may be pain free in as little as several days, although typically this may take 2 – 3 weeks. It is important to note, however, that injured tissue takes approximately six weeks to restore the majority of its strength in ideal healing conditions. Care must therefore be taken when returning to activity during this period.
Physical therapy for a facet joint sprain
Physical therapy for a facet joint sprain can hasten the healing process, ensure an optimal outcome and minimise the likelihood of future recurrence. Treatment may comprise:
Contributing factors to the development of a facet joint sprain
- soft tissue massage
- electrotherapy (e.g. ultrasound)
- dry needling
- postural taping
- the use of a back brace
- the use of a lumbar roll for sitting
- activity modification advice
- biomechanical correction
- ergonomic advice
- clinical Pilates
- exercises to improve flexibility, strength, posture and core stability
- a gradual return to activity program
There are several factors that may contribute to the development of a facet joint sprain. These factors need to be assessed and corrected with direction from a physical therapist and may include:
Other intervention for a facet joint sprain
- poor posture
- lumbar spine stiffness
- a sedentary lifestyle
- poor core stability
- muscle weakness or tightness
- inappropriate lifting technique
- being overweight
- a lifestyle involving large amounts of sitting, bending or lifting
Despite appropriate physical therapy management, a small percentage of facet joint sprains fail to improve and may require other intervention. This may include pharmaceutical intervention, investigations such as an X-ray, CT scan or MRI, or assessment from a specialist. A corticosteroid injection into the facet joint may sometimes be used to help alleviate symptoms. The treating physical therapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically.