Facet Pain

by Jon H
(Houston TX)


Hey Doc! Thanks for having such an informative website. I'll cut to the chase. I have bad facets, real bad facets. In addition at L5-S1 I have a naturally occurring fusion. One day I was getting out of my chair and I could not extend fully upward. I had always had LBP since I was a kid but never knew why nor did I care. Pain is not a big deal to me. However ROM is! I don't want to be paralytic. I was talking one day with a Chiro buddy and he asked to see me do a deep knee bend. I could not go past 90. Not because of pain but, just because I could not physically do it. He started me doing weighted squats and dead-lifts as he is a huge advocate of these two exercises. Everything was going great with my new found range of motion but I still had localized LBP. So I snuck over to one of his machines that was a back extension machine with resistance. I was sure that if I powered through a bunch of reps the back pain would resolve itself. Wow I was wrong. I herniated a disk that day. The L4-L5 disk just above my fused vertebrae. It took me two years to recover from it. I am now squatting in the 400s and I am healed completely from that disk.

HOWEVER, the facets are still an issue. I have come to know the difference between the two. My facets are local on me and maybe slightly spreading slightly spreading into the butt.

Whereas the disc pain was radicular and shot down to my calves. My question to you is this, can my facets get so bad that it would cause instability in my spine or even paralyzation? I will NEVER stop squatting because it has done so much for my ROM and my overall well being. It hurts like a MOFO when I go heavy but, the next day I am fine. If I continue this, will I be sorry? My Chiro buddy says I am stuck with the pain unless I go get an Radio Frequency Ablation. I really, truly, do not give a darn about the pain. I just don't want to become immobile. What are your thoughts on this? Blessings to you doc.

-Jon

Hello Jon,
It's well known that if you have a natural fusion, what's known as sacralization in radiological terms, that the level above is the vulnerable one.

But often only one facet is sacralized, or asymmetrical, and then the biomechanics gets screwed up.

One correction: facets can certainly also cause radicular pain, but the difference is that with a disc you are more likely to have forward bending pain, and facet radicular pain when you bend backwards and sideways. The latter is more common in the older person. How old are you?

There are four exercises I like for facet problems: The hip hike, the pelvic tilt, the cobra and cat and camel. Use the sitesearch function at C-H and you'll find them. All four need to be done carefully and gently initially, until you are used to them. No perfect exercise that fits everyone.

Inversion traction sometimes can make a huge difference. Some gyms have them. Strapped in by the ankles and hang upside down. Not if you BP is raised.

Remember, the Olympics is not your goal. Exercise should make you stronger and give you less pain. Overdo it, and you'll just aggravate your problems.

Good luck
Dr B

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Jan 23, 2013
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Thank You!
by: Jon H

Doctor, thank you so much for the information on the pt protocols. You are very kind to run such a helpful website. I am going to look at the exercises after I type this and I will try them out first thing in the a.m.

However, I am still curious. Is pain the only thing I have to worry about? Without the protective cartilage in the joint, am I doing more harm than good by performing squats, deadlifts etc? I am no longer worried about the disc as I have little pain bending forward an even though I am fused at l5-S1 I have remarkable flexibility and can touch my closed fists on the floor in front of me with ease.

Its only when the facet is loaded that I experience a great deal of pain. Doctor, this bone on bone friction, can it cause another fusion to occur one day or can I develop nerve damage?

I have, according to the MRI, gone through hypertrophic changes at the L4-L5 joint. Is there a way to regenerate the facets naturally protective cartilage?

BTW, in answer to your question, I will be 40 tomorrow :) Thanks again doc!

Pain is your friend, Jon. It's telling you you're doing something wrong. If loading those facets causes a great deal of pain then clearly those hypertrophic facets are complaining. It's cartilage on cartilage.

Lots of research now, only unloading the cartilage will allow the cartilage in knees, hips, ankle, and presumably facet joints will allow the cartilage to regrow.

I wonder what you're trying to achieve by going heavy on the squats? Bit over the hill for the Olympics, eh?

Yes, those enlarged facets can certainly pinch the nerve, it's called lumbar stenosis. It's dependent in part on the shape of your spinal canal, whether the ligamentum flavum is thickened and the shape of those facets. Take a look at this page: Lumbar Facet arthropathy …

You're obviously fit and strong, and that's an enormous plus. My big recommendation is to go for more reps, but lighter. And those morning back exercises.

good luck,

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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