Facet arthritis: What to do? (Diagnosis and treatment)

degenerative disc disease at the L4-L5 level

Facet osteoarthritis is a common pathology that contributes significantly to cases of back pain. It is estimated that 14 to 41% of people suffering from low back pain have lesions characteristic of this condition.

This article written by a physiotherapist will begin by defining facet osteoarthritis, then provide an anatomical reminder of the facet joints. Next, we will discuss the symptoms, causes, and treatment options of this condition.

Definition and anatomy

facet osteoarthritis is an osteoarthritis which concerns the posterior inter-apophyseal joints of the spine, also called facet joints.

We can suffer fromfacet osteoarthritis in the lumbar region (in the lower back), but also at the cervical level.

Good to know: Facet osteoarthritis differs fromlumbar arthritis. The first concerns the joints located behind the vertebrae while the second occurs at the expense of intervertebral discs forward.

Facet joints: short anatomy lesson

The facet joints, also called posterior interapophyseal joints (“facet joints” in English), are the joints that connect the vertebral arches.

The articular surfaces of these joints are cartilaginous. Articular cartilage is an anatomical structure that lines the bony ends of joints. This allows frictionless sliding of these joints.

The facet joints are surrounded by a joint capsule. This capsule is a kind of sheath that keeps them in place. Its thickness varies depending on the location in the spine: it is thinnest in the neck (cervical vertebrae), a little thicker in the back (thoracic vertebrae), and thickest in the lower back (lumbar vertebrae).

The facet joints have inclinations that vary depending on the types of vertebrae (cervical, thoracic, lumbar). These variable inclinations grant several possibilities of movement to these joints. They allow rotation, inclination and flexion/extension movements of the spine.

Note that the spinal nerves emerge through foramina (holes) at this level, and can be compressed in the event offacet osteoarthritis.

What is osteoarthritis?

In facet osteoarthritis, we observe a destruction of the articular cartilage which thins, cracks and eventually disappears. Once the cartilage is destroyed, all other joint structures can be affected. The vertebral arches, synovial tissue as well as the joint capsule can be affected.

These lesions will then sometimes be responsible for pain in the spine.

Symptoms and Diagnosis of Facet Osteoarthritis

When the articular cartilage is destroyed, there is a joint pinching, that is, a reduction in the space separating the two ends of the bony processes of thefacet joint.

The cracks within the articular cartilage extend to the subchondral vertebral processes (under the cartilage). We note a bone condensation zygapophyses which become dense.

We also observe a formation of thick abnormal bone cells at the bone ends called osteophytes or "parrot beaks".

During'facet osteoarthritis, we can have a fluid effusion intra articular. This is the synovial fluid produced abnormally in large quantities following an inflammatory reaction of the synovial tissue.

Indeed, bone cartilage, as it deteriorates, releases substances that irritate the synovial membrane. This leads to an inflammatory process.

In these circumstances, this synovial fluid produced is also abnormal in quality, and no longer fulfills its main role of protecting the cartilage. It produces the opposite effect by further accelerating its destruction.

Origin of pain in facet osteoarthritis

In facet osteoarthritis, the pain does not come directly from the damaged cartilage, because it has no nerves.

It comes from the structures around the cartilage: the synovial tissue, the bone under the cartilage, the tendons and the ligaments. These parts contain nerve endings that can cause pain.

Sometimes nerves can even grow abnormally inside the damaged cartilage, making the pain worse (this is called neo-neurogenesis).

Characteristics of pain

The pain felt duringfacet osteoarthritis vary depending on the patient. They are more or less intense, marked by periods of “crises” and periods of calm.

This pain generally occurs after exercise or after being static for a long time in the same position. It is therefore a mechanical pain. It usually goes away at rest.

In addition, depending on the topography of the osteoarthritis (cervical or lumbar), the pain can radiate towards the upper limbs (cervical facet osteoarthritis) or lower (lumbar facet osteoarthritis).

For example, we can witness a symptomatology of lumbago typical accompanied by sciatica or cruralgia if it is a lumbar attack. Sometimes hip pain and knee (knee pain) can be felt.

Besides pain, the other signs are:

  • Reflex muscle spasms
  • Hypertrophy of the articular masses with the consequences of a limitation of joint movements as well as a joint deformation sometimes visible at the level of the back
  • Spinal canal stenosis.

Paraclinical diagnosis

The diagnosis offacet osteoarthritis as the diagnosis of most osteoarthritis of other joints can be made with a simple standard x-ray. The cartilage itself is not visible on the images but indirect signs can confirm osteoarthritis.

It is :

  • joint pinching (reduction of the space between the two ends of the zygapophyses)
  • subchondral bone condensation (the vertebral arches concerned appear whiter than normal vertebrae)
  • the presence of osteophytes around the facet joint.

Causes

The intervertebral discs and l'facet joint form a functional whole. A violation of the intervertebral disc modifies the geometry of intervertebral movements.

This is how an anomaly of the intervertebral disc such as herniated disc or a disc pinch can affect thefacet joint. In return, thefacet osteoarthritis is capable of aggravating disc disease (pathology of the intervertebral disc).

Furthermore, it seems that genetic factors play an important role in the occurrence offacet osteoarthritis. Various other factors are also involved such as:

  • age
  • the weight
  • excessive physical activity 

Treatment: what to do?

Treatment approachesfacet osteoarthritis are similar to all possible treatments of thelumbar arthritis. A specialist can then adapt the treatment according to the needs of each patient among the solutions if after:

Repos

Following a painful episode of back pain, the first instinct is to rest until the pain passes.

Although rest is often necessary, it is important to understand that too much rest can make your condition worse rather than better.

For what ? Because the harmful effects of long-term inactivity (like muscle weakness or joint stiffness) can limit your recovery, and make pain worse over time.

Medication

To relieve pain, inflammation and muscle tension, the doctor may prescribe appropriate medications.

Among the medications prescribed are:

  • Anti-inflammatories
  • Pain relief
  • Muscle relaxants
  • antiepileptic
  • Antidepressants

Note: The doctor will choose the type of medication to prescribe to you based on your symptoms, and will adjust the doses. Do not hesitate to consult if your pain persists.

Physical therapy

Several therapists and practitioners are involved in the treatment of facet osteoarthritis. The doctor often refers to physiotherapists (physiotherapists), although some patients also consult osteopaths. Overall, the goals of these therapies are similar, and include:

  • Reduction of inflammation via massages, gentle mobilizations and analgesic modalities
  • Reduction of muscle tension through massages and relaxation techniques
  • Improve mobility and flexibility through active and passive stretching
  • Strengthen the core muscles through specific and adapted exercises

Note: Each therapist can bring unique expertise. It is important to find a practitioner you trust, and who has experience with cases of herniated disc.

Accessories and products

In addition to treatments received by a therapist, many patients opt for back pain relief products and accessories because of their effectiveness on their pain.

Although we often observe beneficial effects linked to various accessories, we must realize that they have limits.

Mainly, the products available on the market do not treat the cause of the herniated disc, and are mainly useful for reducing pain in the short term.

They should therefore not replace comprehensive care including appropriate and progressive physical exercises. Obviously, it is best to consult a health professional so that they can suggest the best tools to use, as well as other treatments specific to your condition.

Some of the most popular accessories include (click on the item you are interested in for purchase options):

acupressure mat
Wellax acupressure mat with cushion – specifically relieves tension and promotes circulation – massage mat in a set including acupressure cushion and carrying bag
  • 🧘 𝐔𝐍 𝐄𝐍𝐒𝐄𝐌𝐁𝐋𝐄 𝐔𝐍𝐈𝐐𝐔𝐄 𝐓𝐎𝐔𝐓-𝐄𝐍-𝐔𝐍 – Wellax acupressure set leaves nothing to desire: For a complete and perfect wellness experience, you will receive a matching spiked cushion with our acupressure mat!
  • 🧘 𝐋𝐈𝐁È𝐑𝐄 𝐃𝐄 𝐋𝐀 𝐓𝐄𝐍𝐒𝐈𝐎𝐍 – Our fakir mat stimulates the muscles, promotes circulation and can thus effectively relieve tension. This is how you fight annoying back and neck pain!
  • 🧘 𝐃𝐈𝐒𝐒𝐈𝐏𝐄 𝐋𝐄 𝐒𝐓𝐑𝐄𝐒𝐒 𝐑𝐎𝐔𝐓𝐈𝐍𝐈𝐄𝐑 – Whether after a training session, a match or a hard day work: The Wellax acupuncture mat is the ideal support for releasing daily tension. Pure relaxation for body and soul!

Last updated on 2024-06-21 / Affiliate links / Images from the Amazon Partners API

Local alternative (French product)

Lumbar belt heated
GINEKOO Heated Back Belt, Breathable Back Belt with Rechargeable Battery Heating to Relieve Lower Back Pain, Lumbar Support for Herniated Discs, Sciatica(XL)
  • 【Powerful 360° Support】With 4 stainless steel supports and 2 steel springs placed along the waist, the back brace for heavy lifting provides strong 360° vertical support for the lower back and allows for optimal decompression of the spine, thereby preventing back injuries caused by lifting dumbbells, prolonged standing or sitting, household chores and work.
  • 【Relieve Pain】The ergonomic back support provides strong support for the lower back and abdominal muscles, increasing pressure around the waist to prevent fatigue, strain and other back-related injuries. Relieve waist muscles, herniated discs, sciatica, scoliosis, etc. when wearing the back support belt.
  • 【3 Heating Modes】The back brace for lower back pain contains a heating pillow fixed by Velcro, which you can easily operate via the controller. There are 3 heating settings (low, medium, high) that allow you to adjust the temperature as needed to promote blood circulation and relieve back pain.

Last updated on 2024-06-21 / Affiliate links / Images from the Amazon Partners API

Local alternative (French product)

Ergonomic back cushion
Car Lumbar Cushion for Back Back Support for Office and Car Chairs, Ergonomic for Back Seat
  • ✨Premium Material: Our lumbar support cushion is filled with new temperature sensitive sponge, the lumbar support can adjust the contour of your back according to the temperature. The outer layer of lumbar cushion is made of high quality breathable fabric. The back support cushion fabric is comfortable and soft, not easy to fade. The parts of the lumbar cushion have been certified and are safe and harmless to human health.
  • ✨High-quality design: The back support cushion for chair is ergonomic, and the pillow for back pain has a partitioned design, the memory foam back cushion can support your back curve and promote healthy posture. The lumbar support cushion for chair uses elastic straps to keep the lumbar support cushion for sofa firmly fixed on the seat.
  • ✨Protect your health: With our car back support, you can better protect your spine, car back support office chair Helps relieve lower and middle back tension caused by prolonged sitting or driving. If you often experience back pain due to prolonged sitting, you should definitely try an office chair back cushion.

Last updated on 2024-06-21 / Affiliate links / Images from the Amazon Partners API

Local alternative (French product)

massage gun
Muscle Massage Gun ALDOM Deep Muscle Massager Massage Device with 30 Adjustable Levels, 6 Massage Heads and LCD Display for Relieving Muscle Aches and Stiffness
  • DEEP TISSUE MASSAGE GUN – ALDOM Muscle Massage Gun for Athletes is ideal for relieving muscle pain, soreness and stiffness, promoting blood circulation and helps speed up warm-up and cool-down. It also helps restore the body faster and can be used as your percussion massager at the gym or sports club, is held with one hand and has a comfortable handle.
  • 6 MASSAGE HEADS + 30 SPEED - The deep tissue massage gun comes with 6 different massage heads to help relieve sore muscles, 30 adjustable speed modes, Choose the speed and massage heads that best suits your needs. your needs (1 to 800 pulses per minute) to target different body parts and muscle groups, Integrate a percussive massage experience. Reduce muscle recovery time.
  • SUPER QUIET AND POWERFUL MASSAGE GUN - Professional handheld percussion massager. Featuring a powerful, high-penetration motor, the deep tissue massager is designed to send waves of relaxation and relief throughout the body, and increase everyday mobility and flexibility with percussive therapy for pain relief joints and muscle pain and prolongs the duration of muscle massage
BURNNOVE Muscle Massage Gun 99 Adjustable Speeds Massage Gun Electric Deep Muscle Massager Portable 8 Heads 2550mAh 3300 RPM LED Touch Screen Low Noise Relieve Pain
  • 💪RELIEVE MUSCLE PAIN – Our massage gun can help relieve tight muscles, aches and stiff backs, relaxes tender tissues. The deep muscle massager quickly removes lactic acid produced after exercise, significantly reducing muscle recovery time.
  • 💪8 MASSAGE HEADS + 99 SPEEDS – The powerful massage gun contains multiple easy-to-replace massage heads that can care for different body parts and muscle groups. The 99 speed adjustment parameters allow you to better choose the vibration speed to reach you the most comfortable state.
  • 💪LED TOUCH SCREEN – The muscle massage gun is equipped with an LED screen, which can display the speed and battery percentage. You can increase or decrease the speed of the electric massager by simply pressing the "+" or "-" button, and it can be adjusted quickly with a long press, which is easy and convenient to use.

Last updated on 2024-06-21 / Affiliate links / Images from the Amazon Partners API

Local alternative (French product)

Natural products

Like accessories and anti-back pain products, natural products and grandmother's remedies are very popular with people suffering from back pain.

Often, these remedies include anti-inflammatory properties to relieve various body pains.

On the other hand, it should be noted that most of these natural products are not scientifically proven. It is therefore important to speak to your doctor before using them, particularly to avoid any interaction with your medications.

Natural remedies that may relieve symptoms include (click on the product you are interested in for purchasing options):

Turmeric

Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.

Powerful Turmeric Capsules 500mg with 95% Curcumin Extract – 180 Vegan Capsules (6 Months) – Turmeric (50:1), Black Pepper (30:1) and Ginger – High Absorption Turmeric Capsules – Made in EU
  • WHY CHOOSE OUR TURMERIC AND BLACK PEPPER CAPSULES? – Turmeric is a very well-known plant…
  • POWERFUL TURMERIC CAPSULES - Turmeric is an excellent source of Vitamin C, antioxidants,…
  • IDEAL AND PRACTICAL FORMULA – The powders we use are delicately harvested,…

Last updated on 2024-06-21 / Affiliate links / Images from the Amazon Partners API

Ginger

In addition to the particular flavor it brings to cooking and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).

Ginger Foot Patches, Pack of 30 Ginger Detox Patches, Anti Swelling Ginger Detox Patch, Foot Detox Patch for Deep Cleansing, Improve Sleep
  • 【Natural Ginger Foot Patches】: Natural Foot Detox Patch with Ginger and…
  • 【Ginger Anti Swelling Detox Patch】: Ginger Detox Patches are natural,…
  • 【Removes Body Toxins】: Ginger Foot Patches helps reduce the buildup of…

Last updated on 2024-06-21 / Affiliate links / Images from the Amazon Partners API

Omega-3

Omega-3s are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove to be very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 

Omega 3 Wild Fish Oil 2000mg – 240 Capsules (120 Days) – High Concentration of EPA (660mg) & DHA (440mg) Supports Heart Function and Normal Vision – Manufactured by Nutravita
  • ✔ WHY NUTRAVITA OMEGA 3 FISH OIL? – Our omega 3 comes naturally from the rich waters of the Peruvian coast. The oils are then distilled for increased purity to provide the highest levels of contaminant-free acids – EPA and DHA, removing metals, PCBs and other toxins. 2 capsules daily, our supplement provides a maximum strength of 660 mg EPA and 440 mg DHA. 240 capsules per bottle for a 4 month supply.
  • ✔ WHY OMEGA 3? Each recommended daily dose of our premium Omega 3 fish oil supplement provides high-potency essential fatty acids – Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) which both help support various functions bodily, especially in the normal functioning of the heart. DHA supports the maintenance of normal brain function and normal vision. All these claims are supported by EFSA
  • ✔ WHAT INGREDIENTS ARE USED AT NUTRAVITA? – We have a dedicated team of pharmacologists, chemists and researchers who work to find the finest and most beneficial ingredients, allowing us to provide advanced, high strength vitamins and supplements that do not contain dyes or flavorings artificial. From *fish* which may NOT be suitable for people with allergies. The soft capsule is made from (bovine) gelatin.

Last updated on 2024-06-21 / Affiliate links / Images from the Amazon Partners API

Lemon eucalyptus

Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.

Promo
Mystic Moments Lemon Eucalyptus Essential Oil – 100ml – 100% Pure
  • Eucalyptus Citriodora Essential Oil.
  • 100% pure.
  • Botanical name: eucalyptus citriodo.

Last updated on 2024-06-21 / Affiliate links / Images from the Amazon Partners API

wintergreen

Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the essential oils most used in aromatherapy. This oil, extracted from the shrub of the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

Promo
Puressentiel – Wintergreen Essential Oil – Organic – 100% pure and natural – HEBBD – 30 ml
  • PROPERTIES ORGANIC WINTERGOOD ESSENTIAL OIL: Wintergreen essential oil is…
  • DIRECTIONS FOR USE: Refer to the instructions or ask your pharmacist for advice, This…
  • PURESSENTIEL DNA: A range of 55 essential oils essential for well-being in the…

Last updated on 2024-06-21 / Affiliate links / Images from the Amazon Partners API

Some practical tips

If you have been diagnosed by your doctor with facet osteoarthritis, it will be necessary to follow the following health and dietary measures:

  • Avoid intense efforts that overload the body so as not to further destroy the bone ends of the joint
  • Avoid extreme and sudden movements if you are not trained
  • Avoid prolonged static positions
  • Consult when you feel pain during physical exertion
  • Consider weight loss if you are overweight or obese
  • See a therapist regularly for better follow-up

Conclusion (the take-home message)

Many patients with back pain suffer from facet osteoarthritis. It is a pathology of the posterior interapophyseal joints of the spine not to be confused with lumbar osteoarthritis.

The main symptom is pain mechanical type disappearing at rest. The plain x-ray makes it possible to make the diagnosis through three capital indirect signs: joint narrowing, subchondral bone condensation, osteophytes.

There is a correlation between the disc disease and l'facet osteoarthritis but genetics, age, weight and intense sport are also risk factors.

Treatment offacet osteoarthritis is no different than thelumbar arthritis in terms of medication and physical means. However, there are lifestyle rules to observe as soon as the pathology is diagnosed. Follow-up by a health professional is important.

Good recovery !

Back to top