Lumbar Facet Joint Arthritis

Introduction

Physical Therapy in North Aurora, Batavia and Aurora for Lower Back

Welcome to Physical Therapy Advantage's patient resource about Lumbar Facet Joint Arthritis.

Arthritis of the lumbar facet joints can be a source of significant low back pain. Aligned on the back of the spinal column, the facet joints link each vertebra together. Articular cartilage covers the surfaces where these joints meet. Like other joints in the body that are covered with articular cartilage, the lumbar facet joints can be affected by arthritis.

This article will help you understand:

  • how the problem develops
  • how doctors diagnose the condition
  • what treatment options are available

Hear from some of our patients who we treated for Back Pain
Joe and his Team are fabulous, knowledgeable and friendly. I came to this practice following major spinal surgery, and I am so pleased with the care I received. I appreciate the level of expertise and...
Joe and his Team are fabulous, knowledgeable and friendly. I came to this practice following major spinal surgery, and I am so pleased with the care I received. I appreciate the level of expertise and care at a smaller independently owned clinic. I recommend Physical Therapy Advantage without reservation for your PT needs. Although Joe was my main provider, I had occasion two work with the two other PTs. Both were excellent! You won’t be disappointed if you give Physical Therapy Advantage a call for your needs. They will listen and provide you with excellent care that goes beyond your scheduled sessions. The front desk staff is courteous and respectful, too. This practice is professional, and I’m glad I followed a friend’s recommendation to give it a try!
Sara M
North Aurora, IL
After a painful back injury, PTA helped immensely in my recovery! I went from limited strength and range of motion to good as new in just a few weeks! I highly recommend them, and I would go back in a...
After a painful back injury, PTA helped immensely in my recovery! I went from limited strength and range of motion to good as new in just a few weeks! I highly recommend them, and I would go back in a heartbeat if/when I need help in the future!
Chris W
North Aurora, IL
Joe King and the staff at Physical Therapy Advantage are terrific. After two total hip replacements and spinal decompression surgery, I had been through several Physical Therapy experiences. My most...
Joe King and the staff at Physical Therapy Advantage are terrific. After two total hip replacements and spinal decompression surgery, I had been through several Physical Therapy experiences. My most recent surgery brought me to Joe and for the first time, I’m confident that Joe’s diagnosis and plan, will put me on the path to pain free independence. I’m grateful to have found Joe and his Team and give them my highest recommendation.
Mike G
North Aurora, IL
I am happy to recommend Physical Therapy Advantage! Joe and his team are competent, professional, and most importantly kind and caring. Joe is very thorough in his evaluation of you and creates a...
I am happy to recommend Physical Therapy Advantage! Joe and his team are competent, professional, and most importantly kind and caring. Joe is very thorough in his evaluation of you and creates a personalized routine to support your individual needs. He explains the proper techniques to you and watches to make sure you are doing the exercises correctly, offering suggestions if needed. He checks in with you to assess progress and answers any questions or concerns. I was very pleased with my progress working with Joe on some low back issues. I was able to resume activities I had stopped due to discomfort and feel confident that I have some new tools in my toolbox to help me in the future.
Eileen O
North Aurora, IL
Quality. Caring. Professional. Community driven. Physical Therapy Advantage stands as a shining star in the North Aurora area. I previously worked there as an aide and was blown away by the amount of...
Quality. Caring. Professional. Community driven. Physical Therapy Advantage stands as a shining star in the North Aurora area. I previously worked there as an aide and was blown away by the amount of care and professionalism Joe, Julie, and the Team carried themselves with. Years later I am now returning as a client for my shoulder and low back pain (I wouldn't think of going anywhere else). Julie has been able to relieve me of back pain that I had previously deemed as "something I will have to live with" as well as helped me with the numbness in my fingers. So yes, I would and have recommended Physical Therapy Advantage to anyone and everyone who needs it.
Andrew W
North Aurora, IL
I recently had back surgery to decompress a nerve that had been compressed for several years along with addressing some spinal stenosis issues.  Once things were sufficiently healed I started working...
I recently had back surgery to decompress a nerve that had been compressed for several years along with addressing some spinal stenosis issues.  Once things were sufficiently healed I started working with the folks at Physical Therapy Advantage.  They are an amazing group.  They listen to you, adjust their approach as-needed, pay attention to the whole picture, and give clear instruction.  I believe that working with them has helped me to heal faster, gain strength without reinjuring myself, and further improved the outcome of the sugery.  I would encourage anyone seeking the help of a physical thrapist to give Physical Therapy Advantage a call.
Teresa L
North Aurora, IL
Joe and his staff at Physical Therapy Advantage are fantastic. I’ve been a client twice and had a great experience both times.The first time was due to severe low back pain (with spinal arthritis...
Joe and his staff at Physical Therapy Advantage are fantastic. I’ve been a client twice and had a great experience both times.The first time was due to severe low back pain (with spinal arthritis and a herniated disc as the primary causes) about five years ago. It had gotten bad enough that I was barely able to crawl, let alone stand up or walk. I saw my primary care doctor and a neurosurgeon and had an epidural steroid injection for the pain before being prescribed physical therapy to see if it helped. It did! Joe was able to figure out what was out of alignment and why, and I was pain-free in a just a few months.I recently had some pain again in my hip and low back and decided to skip the shots and doctor visits and just head straight to physical therapy. I went back to Physical Therapy Advantage since my experience the first time was so good. The second time was just as good - I’m all fixed up just a few months later and have a home stretching and exercise routine to prevent future problems (which I’m about to do after posting this!).Joe is great at diagnosing and explaining exactly what is wrong and how the exercises and stretches he recommends will work to fix it. He and his staff are also positive and friendly. I hope that I won’t have a need for more physical therapy any time soon, but if I ever do, I’ll be seeing Joe again.
Eric B
North Aurora, IL
Great experience overall. I went in with lower back nerve pain hoping to find relief knowing that complete and and total relief is not possible. Through targeted stretching to loosen the joints and...
Great experience overall. I went in with lower back nerve pain hoping to find relief knowing that complete and and total relief is not possible. Through targeted stretching to loosen the joints and muscles involved and exercises design to strength and stabilize the joints and muscles involved, I did find good comprehensive relief for the nerve pain. Joe also provided a good workout plan to maintain the flexibility and strength going forward on my own, it was exactly what I needed.
Daniel T
North Aurora, IL
Joe King and his team are top notch. They are experts at listening and evaluating your area of need. In my case it's knee and hip issues. I walk in with pain in my knee, hip or back and after...
Joe King and his team are top notch. They are experts at listening and evaluating your area of need. In my case it's knee and hip issues. I walk in with pain in my knee, hip or back and after several appointments, I walk out pain free. For me it's muscle tissue massage along with completing the exercises they recommend. I've always had great results with Physical Therapy Advantage and wouldn't consider going anywhere else.
Mike S
North Aurora, IL
Joe, Julie and entire staff was very professional courteous and exceeded my expectations for my recovery of a herniated disk. They were always concerned about my pain level and discomfort. I would...
Joe, Julie and entire staff was very professional courteous and exceeded my expectations for my recovery of a herniated disk. They were always concerned about my pain level and discomfort. I would recommend Physical Therapy Advantage to any one who needs PT. They are the gold standard.
Gary S
North Aurora, IL
As compared to other physical therapists and their regimen, I rate PTA superior in every respect. The initial evaluation was thorough and informative. But most important was the protocol for each...
As compared to other physical therapists and their regimen, I rate PTA superior in every respect. The initial evaluation was thorough and informative. But most important was the protocol for each visit beginning with a 30 minute manipulation/massage performed by Joe or Julie followed by 30 minutes of exercises....varying from visit to visit...specifically selected for my current condition and supervised by an aspiring PT assistant qualified to do so. Can't say enough positive about a team that has helped me through back, knee and leg therapies.
DeAnne Z
North Aurora, IL
I have been in and out of physical therapy going on 10 years now dealing with a combination of inherited genetic spine/joint disorders and arthritic issues. Joe King and his staff have provided me...
I have been in and out of physical therapy going on 10 years now dealing with a combination of inherited genetic spine/joint disorders and arthritic issues. Joe King and his staff have provided me all these years with exceptional care and quality service. From the in-depth initial evaluation to create a specific personal care plan to each appointment where I am given the opportunity to ask questions, express concerns and discuss my at home progress. Joe and his team listens intently, provides feedback and welcomes input in order to work together with the client as a team to come up with the most beneficial long term plan for the client to help ensure success once they are released from therapy and on their own at home. Such quality care is rare today but you will find it here at Physical Therapy Advantage!
Michelle D
North Aurora, IL
A few years ago, a reputable doctor out of Elmhurst recommend Physical Therapy Advantage (specifically Joe the owner) when I needed physical therapy for my lower back. I’m glad I did therapy...
A few years ago, a reputable doctor out of Elmhurst recommend Physical Therapy Advantage (specifically Joe the owner) when I needed physical therapy for my lower back. I’m glad I did therapy instead of going with the surgical option offered to me at the time. I wouldn’t go to anyone else for physical therapy. I’ve since seen Joe for other physical ailments, which tend to pop up as we age, and I’ve been very happy with those results as well. Joe is extremely knowledgeable and professional and it’s nice to know he’s just around the corner if needed.
CCS B
North Aurora, IL
I've had a lower back problem for many years and because of it I've been going to several physical therapy places trying to find some relief. Only when I came to Physical Therapist Advantage I felt...
I've had a lower back problem for many years and because of it I've been going to several physical therapy places trying to find some relief. Only when I came to Physical Therapist Advantage I felt that I finally found the right place. Joe King was the only one to take the time to explain in details why I was having so much pain and what he was planning to do about it. Even though it's not part of my network, I am still going to continue his therapy because I am confident it will help me find the solution to my long and painful situation. Thank you Joe!
Catia M
North Aurora, IL
It was my good fortune to have a friend recommend me to Physical Therapy Advantage after a back injury in the fall of 2012. Word of mouth has always been my preferred way to find a health care...
It was my good fortune to have a friend recommend me to Physical Therapy Advantage after a back injury in the fall of 2012. Word of mouth has always been my preferred way to find a health care provider. Joe King and his associates at Physical Therapy Advantage were always concerned, supportive, encouraging, and professional. By truly listening to my problems and issues, Joe crafted a treatment plan for me that oincluded in-clinic care as well as home exercises to support that care. The results were so positive, that I did not hesitate to return to this clinic when I found out in 2013 that I needed knee replacement surgery. Again, a therapy plan was created for me prior to surgery in June 2014, and then after surgery to enable me to get my new knee strong, and to increase my flexibility when moving it. Once more, after much dedicated care by Joe and exercise work by me, the results were positive. However, osteoarthritis was not done with me yet! In late 2014, I found that I needed both of my hips replaced as well. This was very discouraging news. However, I had such confidence in my surgeon, as well as in my physical therapist, Joe and the staff at Physical Therapy Advantage, I knew that I could face these surgeries and rehabs. Throughout this entire time, I could always count on Joe and his staff to keep me positive and focused on the end result-- to walk without pain! After left hip surgery in Feb. 2015, and then right hip surgery in June of 2015, their subsequent physical therapy sessions and home care exercises, I finally reached my end goal---to walk without pain! It was a hard, 3 yr. long, physically taxing journey but, with the professional care I received from this facility, with all their support and encouragement, I was successful. I highly recommend Joe King and Physical Therapy in North Aurora.
Jan M
North Aurora, IL
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Anatomy

What part of the back is involved?

The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to create the spinal column. The spinal column gives the body its form. It is the body's main upright support.

Human Spine

The back portion of the spinal column forms a bony ring. When the vertebrae are stacked on top of each other, these bony rings create a hollow tube. This tube, called the spinal canal, surrounds the spinal cord as it passes through the spine. Just as the skull protects the brain, the bones of the spinal column protect the spinal cord.

Between the vertebrae of each spinal segment are two facet joints. The facet joints are located on the back of the spinal column. There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made of small, bony knobs that line up along the back of the spine. Where these knobs meet, they form a joint that connects the two vertebrae. The alignment of the facet joints of the lumbar spine allows freedom of movement as you bend forward and back.

Facet Joints

The surfaces of the facet joints are covered by articular cartilage. Articular cartilage is a smooth, rubbery material that covers the ends of most joints. It allows the bone ends to move against each other smoothly, without friction.

Articular Cartilage

Related Document: Physical Therapy Advantage's Guide to Lumbar Spine Anatomy

Causes

Why do I have this problem?

Normally, the facet joints fit together snugly and glide smoothly, without pressure. If pressure builds where the joint meets, the cartilage on the joint surfaces wears off, or erodes.

Each segment in the spine has three main points of movement, the intervertebral disc and the two facet joints. Injury or problems in any one of these structures affects the other two. As a disc thins with aging and from daily wear and tear, the space between two spinal vertebrae shrinks. This causes the facet joints to press together.

Facet joints can also become arthritic due to a back injury earlier in life. Fractures, torn ligaments, and disc problems can all cause abnormal movement and alignment, putting extra stress on the surfaces of the facet joints.

The body responds to this extra pressure by developing bone spurs. As the spurs form around the edges of the facet joints, the joints become enlarged. This is called hypertrophy. Eventually, the joint surfaces become arthritic. When the articular cartilage degenerates, or wears away, the bone underneath is uncovered and rubs against bone. The joint becomes inflamed, swollen, and painful.

Animation of facet arthritis


Facet joint arthritis develops slowly over a long period of time. This is partly because spinal degeneration in later life is the main cause of facet joint arthritis. Symptoms rarely develop immediately when degeneration is causing the problems. However, rapid movements, heavy twisting, or backward motions in the low back can injure a facet joint, leading to immediate symptoms.

Symptoms

What does the condition feel like?

Pain from facet joint arthritis is usually worse after resting or sleeping. Also, bending the trunk sideways or backward usually produces pain on the same side as the arthritic facet joint. For example, if you lie on your stomach on a flat surface and raise your upper body, you hyperextend the spine. This increases pressure on the facet joints and can cause pain if there is facet joint arthritis.

Pain may be felt in the center of the low back and can spread into one or both buttocks. Sometimes the pain spreads into the thighs, but it rarely goes below the knee. Numbness and tingling, the symptoms of nerve compression, are usually not felt because facet arthritis generally causes only mechanical pain. Mechanical pain comes from abnormal movement in the spine.

However, symptoms of nerve compression can sometimes occur at the same time as the facet joint pain. The arthritis can cause bone spurs at the edges of the facet joint. These bone spurs may form in the opening where the nerve root leaves the spinal canal. This opening is called the neural foramen. If the bone spurs rub against the nerve root, the nerve can become inflamed and irritated. This nerve irritation can cause symptoms where the nerve travels. These symptoms may include numbness, tingling, slowed reflexes, and muscle weakness.

Diagnosis

How do health care providers diagnose the problem?

Diagnosis begins with a complete history and physical examination. When you visit Physical Therapy Advantage, we will ask questions about your symptoms and how your problem is affecting your daily activities. This will include questions about where you feel pain and if you have numbness or weakness in your legs. We will also want to know what positions or activities make your symptoms worse or better.

Our Physical Therapist then performs a physical exam to determine which back movements cause you pain or other symptoms. Your skin sensation, muscle strength, and reflexes are also tested.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at Physical Therapy Advantage have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

Physical Therapy Advantage provides services for Physical Therapy in North Aurora, Batavia and Aurora.

Our Treatment

Non-surgical Rehabilitation

Facet joint arthritis is mainly treated nonsurgically. At first, your Physical Therapist at Physical Therapy Advantage may prescribe a short period of rest to calm inflammation and pain. Patients may find added relief by curling up to sleep on a firm mattress or by lying on their back with their knees bent and supported. These positions take pressure off the facet joints.

By evaluating your condition, our Physical Therapist can assign positions and exercises to ease symptoms. Our Physical Therapist may recommend traction. Traction is a common treatment for this condition. It gently stretches the low back and takes pressure off the facet joints.

Although recovery time is different for each individual, as a general rule, our lumbar joint arthritis patients are normally seen a few times each week for four to six weeks. In severe and chronic cases, patients may need a few additional weeks of care.

The Physical Therapists at Physical Therapy Advantage create a personalized program to help each patient regain back movement, strength, endurance, and function. Hands-on treatments such as massage and specialized forms of soft-tissue mobilization may be used initially. We use these treatments to help patients begin moving with less pain and greater ease.

Our Physical Therapist may also prescribe strengthening and aerobic exercises. Strengthening exercises focus on improving the strength and control of the back and abdominal muscles. Aerobic exercises are used to improve heart and lung health and increase endurance in the spinal muscles. Stationary biking offers a good aerobic treatment and keeps the spine bent slightly forward, a position that gives relief to many patients with lumbar facet joint arthritis.

We will show you how to improve strength and coordination in the abdominal and low back muscles. Our Physical Therapist will also evaluate your workstation and the way you use your body when you do your activities.

Post-surgical Rehabilitaiton

Outpatient Physical Therapy, such as the programs offered at Physical Therapy Advantage, is usually prescribed only for post-surgical patients who have extra pain or show significant muscle weakness and deconditioning.

Patients usually don't require Physical Therapy after facet rhizotomy. We may prescribe a short period of therapy when patients have lost muscle tone in their back and abdominal muscles, when they have problems controlling pain, or when they need guidance about returning to work.

Although recovery time varies, as a general rule, patients who require formal rehabilitation after facet rhizotomy will probably only need to attend sessions for two to four weeks and should expect full recovery to take up to three months.

Patients who have had lumbar fusion surgery normally need to wait at least six weeks before beginning a rehabilitation program. Again, although individuals recover at different rates, lumbar fusion patients typically need to attend therapy sessions for six to eight weeks and should expect full recovery to take up to six months.

During Physical Therapy after surgery, our therapist may use treatments such as heat or ice, electrical stimulation, massage, and ultrasound to help calm pain and muscle spasm. Then we will teach you how to move safely with the least amount of strain on the healing back. As your Physical Therapy Advantage rehabilitation program evolves, you will do increasingly challenging exercises. Our goal is to safely improve strength and function.

As your Physical Therapy sessions contine, our therapist will help you get back to the activities you enjoy.  You may need guidance on how to change the way you go about your activities and which activities are safe. Ideally, patients are able to resume their normal activities.

When recovery is well under way, regular visits to Physical Therapy Advantage will end. Although we will continue to be a resource, you will be are in charge of doing your exercises as part of an ongoing home program.

Physical Therapy Advantage provides services for Physical Therapy in North Aurora, Batavia and Aurora.

Physician Review

Your doctor may order X-rays to reveal if there are problems in the bone tissue in and near the facet joints. The images can show if degeneration has caused the space between the vertebrae to collapse and may show if bone spurs have developed near the facet joints.

Degeneration

When more information is needed, your doctor may order magnetic resonance imaging (MRI). The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. This test gives a clear picture of the facet joints to see whether they are enlarged or swollen. This machine creates pictures that look like slices of the area your doctor is interested in. The test does not require dye or a needle.

A computed tomography (CT) scan may be ordered. This is a detailed X-ray that lets your doctor see slices of bone tissue. The image can show whether the surface of the joint has eroded and whether bone spurs have developed.

A diagnostic injection may be used to locate the source of pain. The doctor uses a long needle to inject a local anesthetic (numbing medication) into either the joint or into the nerve that goes to the joint. The doctor watches the needle on a fluoroscope to make sure it reaches the correct spot. A fluoroscope is a special X-ray television that allows the doctor to see your spine and the needle as it moves. Once the doctor is sure the needle is in the right place, the medicine and a special dye are injected. The doctor watches the dye to make sure the medication is correctly placed. The results from the injection help the doctor make the diagnosis. If pain goes away, it helps confirm the source of pain.

Your doctor may prescribe anti-inflammatory medication, such as a nonsteroidal anti-inflammatory drug (NSAID) or aspirin. Muscle relaxants are occasionally used to calm muscles that are in spasm. Oral steroid medicine in tapering dosages may also be prescribed for pain.

Patients who still have pain after trying various treatments may require injections into the facet joint or the small nerves that go to the joint. An anesthetic is used to block pain coming from the facet joint. The procedure to inject the medication into the joint is similar to the diagnostic injection described earlier. A steroid medication is occasionally used instead of the anesthetic. There is no strong evidence that these injections work. However, they seem to have some good short-term results with few side effects, so they shouldn't be abandoned completely. Doctors often have their patients resume Physical Therapy treatments following an injection.

Surgery

People with facet joint arthritis rarely need surgery. However, facet joint arthritis is a primary source of chronic low back pain about 15 percent of the time. After trying other types of treatment, some of these patients may eventually require surgery. There are several types of surgery for facet joint arthritis. The two primary operations are:

  • facet rhizotomy
  • posterior lumbar fusion

Facet Rhizotomy

Rhizotomy describes a surgical procedure in which a nerve is purposely cut or destroyed. Facet rhizotomy involves severing one of the small nerves that goes to the facet joint. The intent of the procedure is to stop the transmission of pain impulses along this nerve. The nerve is identified using a diagnostic injection (described earlier). Then the surgeon inserts a large, hollow needle through the tissues in the low back. A special probe is inserted through the needle, and a fluoroscope is used to guide the probe toward the nerve. The probe is slowly heated until the nerve is severed.

Posterior Lumbar Fusion

Facet joint arthritis mainly causes mechanical pain, the type of pain caused by wear and tear in the parts of the lumbar spine. Posterior lumbar fusion for facet joint arthritis is mainly used to stop movement of the painful joints by joining two or more vertebrae into one solid bone (fusion). This keeps the bones and painful facet joints from moving.

In this procedure, the surgeon lays small grafts of bone over the back of the spine. Most surgeons will also apply metal plates and screws to prevent the two vertebrae from moving. This protects the graft so it can heal better and faster.

Grafts of Bone

Related Document: Physical Therapy Advantage's Guide to Posterior Lumbar Fusion

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