Physio Penrith Facet Arthropathy Back Pain Treatment
Treatment of Facet Arthropathy Back Pain at Sydney Muscle & Joint Physio Penrith
What is facet arthropathy back pain?
Facet arthropathy as it relates to low back pain is also known as lumbar facet arthrosis and is a degenerative syndrome that typically occurs secondary to age, obesity, poor body mechanics, repetitive overuse and microtrauma. Research has linked facet joint degeneration to degeneration of intervertebral discs, showing that intervertebral disc degeneration likely occurs before facet joint arthrosis. One explanation for these findings is the increased mechanical changes in the loading of the facet joints following intervertebral disc degeneration.
Osteophytes are likely to arise at the facet joint entheses where the fibrocartilage extends beyond the original joint space. Facet mediated pain occurs secondary to these arthritic changes, as there is rich innervation of the entire joint complex.
What are some common names for joint arthropathy back pain?
Other terminology for facet arthropathy back pain can include facet joint arthritis, spondylosis, facet joint syndrome, joint mediated back pain, facet joint osteoarthritis, lumbar facet syndrome and facet arthrosis.
What are the symptoms of facet arthropathy back pain?
Lumbar facet arthropathy back pain will typically present as unprovoked chronic low back pain and it is impossible to diagnose based on history and physical exam alone. Clues that may point to the facet joint as the pain sensitive tissue may include pain localised over the back with a non-dermatomal referral pattern. If there is referred pain it will typically be around the buttock and thigh and is rarely felt below the knee. Numbness and weakness of the lower extremities are unlikely, however patients with osteophytes and facet joint hypertrophy that have led to lateral recess stenosis may present with radicular symptoms.
Diagnosis of facet arthropathy back pain
Physical examination may reveal pain on palpation over the lumbar paravertebral region over the transverse processes and paraspinal muscles. Pain may be aggravated by spinal extension (leaning backwards with rotation). Neurological findings, such as lower limb sensation, motor strength, and deep tendon reflexes should be normal. The Kemp test or the extension-rotation test is a provocative test that has been described as being potentially useful for diagnosing facet joint pain, however some research has shown that the Kemp test has poor diagnostic accuracy, with a sensitivity under 50% and specificity under 67%.
MRI remains a superior diagnostic tool to rule out non-facet mediated pain. Classic radiographic findings in standard lumbar radiographs (x-ray) should contain oblique views, as the facet joints are in an oblique position. Imaging may reveal narrowing of the facet joint space, subarticular bone erosions, subchondral cysts, osteophyte formation, and hypertrophy of the articular process.
Treatment of facet arthropathy back pain
At Sydney Muscle & Joint Clinic Penrith our physiotherapy philosophy is to provide evidence-based treatments for facet arthropathy back pain. Treatment of low back pain should always begin with conservative management and this remains true for facet mediated low back pain. Physiotherapy-led treatment is the cornerstone of management of low back pain and should include education and advice, repeated joint stretching (McKenzie Method), and exercises tailored to strengthen the trunk and gluteal muscles.
Pain medications, including simple analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are widely considered the first line for treatment of facet arthropathy back pain.
Patients who fail a course of conservative management are considered candidates for a diagnostic block. If the diagnostic block is successful, more invasive treatment can be considered. Intra-articular steroid injections are a controversial treatment, with level III evidence to support their use. Facet arthropathy is rarely an indication for surgical intervention in itself, but when large osteophytes or large synovial cysts impinge upon other surrounding structures and lead to lateral recess stenosis, nerve root impingement, and radiculopathy a lumbar facetectomy may be performed. Medial facetectomy is the most commonly performed form of facetectomy and is often performed in conjunction with laminectomy.