Tamworth Osteopath explains back pain and muscle spasm

Tamworth Osteopath John Williams gives reassurance to Staffordshire back pain sufferers by explaining a common cause of low back pain and muscle spasm. John who is Clinic Director at the 2008 Award Winning Atlas Pain Relief Centre in Tamworth town centre explains about the acute nature of a lumbar spine facet lock and the severe reaction that may follow.

Atlas Pain Relief Centre have an excellent website www.atlaspainrelief.com and are members of the local back pain directory www.tamworthchiropractor.com but wish to stress they are not Tamworth chiropractors.

Low back pain involving the Facet ( zygapophysial ) joints

The facet joints are synovial joints which help support the weight and control movement between individual vertebrae of the spine. They work together alongside the intervertebral discs to form a functional working unit.

The facets direct the plane of motion at each vertebral segment which is dependant on their angle and orientation. Throughout the spine the angles and orientations differ which alters the possible movement allowed in that area.

The facets have an articular cartilage and articular capsule which allow movement but provide stability.

Facet joints have a nerve supply from two levels, one branch arises from the nerve root at that level and the second from the level above.

When functioning correctly, facet joints move freely controlling the movement of the spine.

Symptoms

Facet joint pain may arise directly from the facet joint either from inflammation or nerve impingement. Common symptoms associated with this condition are adjacent muscle spasms which can pull the patient out of alignment, leading to a guarded posture.

Often patients will report "I just bent over to tie my shoe laces and my back went and I couldn´t move"

The usual acute attack of back pain involving facet joints occurs suddenly with no warning. It can appear dramatic and patients are in much discomfort and cannot move very well. This spasm of adjacent muscles is the bodies way of protecting the area and tries to prevent you from moving and incurring more damage.

Symptoms can vary greatly and be confused with disc related disorders as its possible for patients to report referred pain into the lower extremities.

The traditional facet locking syndrome may lead to such an acute attack but can be resolved successfully by freeing the offending joint and restoring normal function .

This should only be attempted by suitably qualified practitioners following the correct diagnosis.

Examination

Generally testing for facet joint involvement in low back pain would involve trying to reproduce the symptoms and find aggravating and relieving factors.

What we need to determine is what is the cause, as many causes of low back pain have overlapping symptoms.

Compression of the facet joints will aggravate a troublesome joint so testing may involve this course of action.

Tests

Seated Quadrant test

Patient seated with arms folded, practitioner standing behind them.

Practitioner passively moves patient into flexion to the right and compresses spine by bearing down on their shoulders. Next moving into flexion to the left and repeat procedure. Follow this by taking patient into left and right extension and compressing again. If we can imagine this to be providing compressive forces into 4 separate corners such as the 4 legs on a chair for example. We would be compressing each chair leg in turn.

Findings

Although all tests are not definitive, if we observe the anatomy we should by flexing the spine, open up the facet joints but instead put pressure on the anterior portion of the lumbar discs.

If pain is reproduced and neurological symptoms such as sciatic pain occurs then this may indicate disc herniation and nerve root impingement.

If pain is produced when patient is moved into extension then this begins to compress the facet joints,and if they are responsible the symptoms will be aggravated.

During active movement the patient cannot bend backwards if facets are not functioning correctly.

Conclusion

I generally find that separating similar causes of acute low back pain is not an easy task as many conditions have overlapping symptoms. Experience in dealing with these problems is invaluable and much can be gained from the case history taking.

Sudden onset may indicate facet joint involvement, gradual onset is more often disc related. There are many other factors that need consideration and should facet joint involvement be evident this could be due to disc narrowing which would cause loss of disc height and consequently produce an approximation of the facet joint making it more likely to give trouble.

Facet joint involvement in low back pain is common but is only one of many causes of low back pain which needs to be diagnosed correctly before being treated successfully.