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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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.

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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