First in a Series of Lumbar Spine (Lower Back) Pain Syndromes
Athletics and lower back pain is almost oxymoronic. Over 10% of all athletic injuries occur in the lumbar spine! As in most athletic endeavors, especially repetitive stress and most strength based, the integrity of the lower back is constantly challenged. The lower back, or lumbar spine, is the pivotal anatomical region that must be fully functional and structurally sound to off-set the load stresses imposed during athletic activities.
The lumbar spine is composed of five large vertebral bodies sandwiched by cartilagenous discs acting as dynamic cushions, facet joints allowing movement and a host of ligaments and layers of spinal muscles acting as stabilizers and functional movement mechanisms. The lumbar spine should exist with a soft “C”curve (60 degree arc lordosis) with the convexity toward the front of the body. This lordosis provides the platform for healthy movement and stability. When there is too much of a curve/lordosis, the stress and pressure on the lower back (facet joints) can generate pain and inflammation and lead to injury.
Symptoms of Facet Syndrome
*Most will have a persisting point tenderness overlying the inflamed facet joint in lower back
*There will be loss of spinal muscle flexibility (guarding)
*Increased pain with extension (leaning backward)
*Facet joints radiate pain into buttocks and back of thigh but will not travel below the knee
*Similarly, cervical (neck) facet joint problems may radiate pain locally or into the same side of the head or shoulder
*Headaches (cervical spine facet problems)
*Deep, dull, aching pain
*Stiffness, particularly first thing in morning
**Frequently, when an acute lumbar/cervical facet joint is inflamed/injured it can imitate symptoms of a herniated disc, a deep infection, a spinal stress fracture, a torn muscle or even an intra-abdominal problem.
Diagnosing Facet Syndrome
*History as told by patient to reveal mechanism of injury
*Physical Evaluation including Provocation tests to replicate pain patterns
*Postural/Structural evaluation for assessment of gravitational forces on facets
*Foot faults that contribute to facet joint compression stress
*Kinetic chain imbalances such as pelvic unleveling, torsion, leg length discrepancy, etc.
*Iliopsoas shortness and/or weakness
*Weak abdominal core muscle integrity
*Lumbar muscle inflexibility and/or myofascial restriction
**Weight bearing X-Ray study with oblique views to assess stress/load patterns and degenerative changes
**CT Scan and/or MRI for inflammatory changes around the facet joints and in the adjacent bone tissue
Managing Facet Syndrome
*Clear out biomechanical stress and imbalances via chiropractic adjustments and orthotics if necessary
*Support injured tissue with physiotherapy such as interferential current therapy, pulsed wave ulstrasound, ice therapy, iontophoresis, cupping therapy
*Myofascial release therapy to open up fascial planes to allow facets to operate without restrictions from fascial tissue
*Employ a Flexion Bias lumbar/core stabilization program to unload the facet impaction and inflammation
*Avoid impactful fitness activities and extension biased exercises
*Natural anti-inflammatory protocol: Proteolytic Enzymes (Protrypsin), Natural COX2 Inhibitors (Inflavonoid), Omega three fatty acids (Fish Oil), and Joint Factors (DJD Factors)
**Recalcitrant cases consider pain management protocols such as facet joint injections