Lumbar Facet Arthropathy Spondylolysthesis

Lumbar facet arthropathy spondylolysthesis causes lower back and leg pain.

This is a not uncommon condition found at the chiropractic clinic. It's often associated with severe leg pain.

The lumbar facet joints are subject to wear and tear, particularly after a hyperextension injury that was not properly cared for. The ensuing chronic fixation leads invariably to immobilisation arthritis and hyaline cartilage degeneration.

In short, the hyaline cartilage that lines the ends of bones is dependent on movement for correct nutrition. Immobilise or fixate a joint and it rapidly becomes arthritic.

This page was last updated by Dr Barrie Lewis on 27th June, 2019.


Shall we start by getting this jaw breaker out the way, otherwise you my be tempted to leave this page immediately!

Spondylolysthesis is a spinal condition where one vertebra slides forwards on it's neighbour below. There are two main causes:

1. Trauma which fractures the "pars", usually in childhood, but it's also a stress fracture the sportsmen get. It's very common in cricketers. Fast bowlers get it.

2. Degenerative change (arthropathy) in the facet joints causing the shape and orientation to change, allowing the vertebra to slide forwards. It occurs in the older person.

Because of many links to our two sister sites, and we have been accused of being a link farm, a dreaded connotation. It's irritating but to find links to the subjects in bold you have to copy and paste it into the site search function in the navigation bar on your left.

X-ray showing lumbar facet arthropathy with a spondylolysthesis.

Lumbar facet syndrome

Photograph showing how a skating whiplash injury can cause lumbar facet arthopathy.

Lumbar Facet Arthropathy Spondylolysthesis


Mrs G is a 75-year old woman who has had pain in her left buttock for five years. Four months ago she fell down five steps on her buttocks (the staircases in the Nederlands are very steep). A month later the pain started radiating down her the back of her thigh and calf, with tingling on top of her foot.

She couldn't use any power with her left leg without severe pain in the leg. Turning her torso left and right, and straightening up after bending was very painful. The pain in her leg was constant, 24 hours per day. She could never escape it.


A lumbar x-ray showing a spondylolysthesis and lumbar facet arthropathy.

To find links to topics in bold like those below use the site search function in the navigation bar on your left.

  • Looking for a Leg Length Inequality is always tricky. It can't be measured precisely without a special X-ray of the pelvis, which I didn't have, and sometimes it changes after adjusting the pelvis, or even adjusting the foot. However, by eye-balling her pelvis, there was no obvious low side. A mild scoliosis (curvature) however was clearly present. LEG LENGTH INEQUALITY ...
  • There was a marked fixation in the opposite (right) sacroiliac joint, and at the L5-S1 joint (the lumbo-sacral joint). L4 was tender on palpation.
  • Forward bending caused moderate pain in her back and buttock but did not radiate to the leg. Sideways bending, right and left, were mildly uncomfortable.
  • The test of Lasegue for a pinched nerve was very mildly positive at 60 degrees, with pain in the buttock, but not the leg. The Slump test too was mildly positive. SLUMP TEST for sciatica ... for a pinched nerve.
  • There was no numbness, no muscle weakness and the reflexes were normal.
  • The piriformis muscle was very tender with active trigger points. PIRIFORMIS SYNDROME ...
  • Her right hip shows signs of early hip arthritis. Limited flexion, adduction and internal rotation with pain in the groin. HIP ARTHRITIS ...



The radiological report reads:

"Forward slip of the body of L4 in relation to L5, spondylolisthesis, grade 1.

At L4-5 a canal stenosis is seen with facet arthropathy and hypertrophy (thickening) of the Ligament Flavum. Reduced intervertebral foramena right more than links.

At L5-S1 there is also relative canal stenosis, also on the basis of advanced facet arthropathy and hypertrophy of the Ligament Flavum. There is possibly a small synovial cyst at the left facet joint."

A lateral MRI view showing lumbar facet arthropathy and spondylolysthesis.

Certainly there is a very small, tight spinal canal, consistent with our case history and findings. Chronic low back pain, buttock pain and radiating pain to the left foot.

Can Chiropractic possibly help? Does chiropractic help have a spinal stenosis explanation and solution...?

A cross section MRI showing lumbar facet arthropathy and spondylolysthesis.


Something didn't quite fit. With such severe pain in the leg, I would in the first place have expected pain in the limb when she bent either forwards, or sideways, backwards; and that the tests for a pinched nerve would be strongly positive.

But no, this is not a pinched nerve in the normal sense, but irritated and severely inflamed by the complex toxins exuded by fixated joints.

We had to wait a week, before starting the treatment, for the xrays and scan which brought forth the explanation. Extremely degenerate facet joints at L4 on 5 that had allowed the fourth lumbar vertebra to slide forwards; spondylolysthesis.

Interestingly her symptoms were partly from the S1 nerve root from the fixated L5 joint and partly from the L5 fibre causing tingling on top of her foot from the spondylolysthesis.

The severe fixation in the right sacroiliac joint anatomy was central to the whole problem.

Treatment: lower back and leg pain

The first three treatments involved the sacroiliac joints and L5 using the Thompson drop protocol, and gentle drop treatments on L5 with her in the side-lying posture. The pain increased after the first two treatments. She was dubious, but I assured her that was normal for a chronic condition.

I modified the treatment to include the very degenerate L4-5 joint. From the case notes:

"Flex iets Li bil. Kemp R en L > Links L5. L5R vast. ZSLR L licht in L bil. L4R, L5L roll drops. Steeds pijn, dus: Prone: R sac hard, L si AS hard. Supine R en L Si, ant bekken. Active release therapie aan de linker hamstring, piriformis en Iliotibial band."

Within five treatment she had 50% less pain, and after seven the pain has completely gone.

We are now busy with rehab, still concentrating on the right hip arthritis which is still tender, though also improving, and I'm pondering the need for a heel lift.

Next week we start with a full examination of her neck, which is also stiff and painful.



Mrs G came in today for her seventh treatment. She's smiling and so am I. She played tennis twice this week, with no ill effect. I'm no longer so happy; that wasn't allowed, but it seems with no negative results.

She added a sentence about the loneliness of growing older. The tennis club is her solution. So be it, she's not just a back.

The pain in her left leg has completely stopped and the Slump test is negative. She still has a little discomfort in the right sacroiliac joint, something she has had for years, which is connected to the arthritis in her right hip.

The right groin is still a little painful when she rotates her hip. We're working on it, Rome wasn't built in a day. Nor were Aachen or Cologne as we say in Europe.

They are both worth a visit, by the way. Especially the Dom in Aachen which is where you'll see the remains of Charlemagne; and the Christmas fair in Cologne is generally acknowledged as the best in Europe; and the chocolate museum is to die for.

Managing these complex cases successfully means addressing each and every part of the syndrome. A mixture of symptoms and signs, in this case the

  1. Muscular condition in her left buttock, the Piriformis.
  2. The fixation at L5.
  3. The spondylolysthesis at L4.
  4. The hip arthritis on the other side.
  5. Thinking about the Leg Length Inequality, and would a heel lift help, or hinder.
  6. Convincing the patient of the need to do daily rehab exercises, to start walking more and sitting less. Tennis, mm???
  7. Persuading them to accept that some things belong to the past. Can they still garden, play tennis, golf, work in a bookshop where lifting boxes of books is required...



Lower back and leg pain is an every-day-event in chiropractic clinics. It's our bread and butter. Sometimes it's routine and straightforward, sometimes it can be extremely complex. Occasionally we have to refer patients for surgery. Occasionally!

More often it's we who are trying to cope with very unhappy patients after Failed Back Surgery (FBS) as it's known in the literature, or the complications of surgery. LOWER BACK AND LEG PAIN ...


Today I had a new patient in her upper fifties with a not dissimilar history, but she went for the surgery. Immediately after the operation she developed a severe foot drop, and could only move about with a walker for two months.

And she still has disabling numbness and tingling in her lower leg. The X-ray reveals another LUMBAR FACET ARTHROPATHY SPONDYLOLYSTHESIS ... I wonder what we can do for her, if anything.

My point? These serious cases of degenerative lumbar spines are an every day affair in chiropractic clinics. Each has to be managed carefully, thoroughly, mostly fairly gently though periodically a good "pak sla" is necessary. A good hiding!

Do we chiropractors always win with these difficult cases? No, of course not, but isn't conservative treatment always worth a try before going for surgery?

It's never far from my mind that a favourite relative died (literaly) after her seventh lumbar surgery, aged forty-two. And it all started with a routine, uncomplicated lower back strain. You can do a lot more damage with a knife in your hand, than just a plain hand!

Plus the risk of infection, not to mention Anaesthetic Alzheimers ...


Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

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 have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is 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 is 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 pain-free. 

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 is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has 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 stroll 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; he has a short leg.

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. X-rays 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 few months 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 is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year 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 could not 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 should not be treating the elderly most medical sites state but that is so much bunkum.

Do you have a problem that is not getting better?

Are you looking for a different slant on your pain?

Do you want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.

You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.

The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.


Spine and pelvis highlighted.


A lumbar hyperextension injury whilst skating.
Falls from horses can be devastating to the spine and pelvis.
A fall on the ice can injure the coccyx and sacroiliac joints.

Bending and twisting

The bending and twisting whilst shoveling snow stresses the lumbar discs.
Gardening can injure the lower back and cause leg pain.
Men on a building site.


Sitting as this woman is doing with the lumbar spine flexed is a common cause of ache in the lower back.
This woman in a car should exercise her lower back every morning.

Short leg?

An x-ray showing how a short leg causes a scoliosis and neck pain.
  • Leg length inequality and Low Back Pain

Lower back and leg pain

A graphic showing the course of the sciatic nerve.

Lumbar facet syndrome

The lumbar facet joints.

Slipped disc

A slipped disc as seen on an MRI.

Sacro-Iliac Joint

Sacroiliac joint location.


An x-ray of the lumbar spine showing how a spondylolysis causes a condition known as spondylolysthesis.


Motion palpation of the sacroiliac joint.
The Flip and Slump tests for a sciatica.
  • Slump Test for sciatica ...
Reflexes tested when lower back and leg pain is present.
The L4 lumbar spine area can cause extensor hallucis longus weakness.