Lumbar Facet Syndrome

Lumbar facet syndrome is acute or chronic inflammation of the lumbar zygapophyseal joint. This is thought to be the primary source of pain in anywhere between 15 to 45% of patients with chronic low back pain. (1-6) The primary cause of most facet syndromes is repetitive stress of the joint capsule or a cumulation of low level trauma. Dysfunction of any portion of the intersegmental joints can lead to a cycle of perpetuation changes, including degeneration in the remaining components. 

Lumbar facet syndrome typically presents with back and/or leg pain. Pain is on one side of the body or the other, but rarely both. General and morning stiffness are associated with changes in the joint. Since the symptoms come from cumulative stress, there is rarely a direct mechanism of injury. 

Contributing factors include:

  • History of trauma

  • Overuse

  • Osteoarthritis

  • Systemic arthropathy

  • Being overweight

Treatment of facet syndrome typically has three components; pain relief, mobility of restricted joints, and functional stabilization. Spinal manipulation has been showing to be very beneficial for facet syndrome. (7) Myofascial release techniques will often be used on the lumbar erectors, quadratus lumborum, hip flexors, hip rotators, gluteal muscles, piriformis, and hamstrings. Rehabilitation will focus on spinal stabilization to help reduce disability, pain, and future episodes of lower back pain. (8) Posture correction and breathing exercises are used for those with dysfunctional respiration.

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1. Ray C. Percutaneous radiofrequency facet nerve blocks: treatment of the mechanical low back syndrome. Radionics. 1982.

2. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity?. Spine. 1994 May;19(10):1132-7.

3. Manchikanti L, Singh V, Pampati V, Damron KS, Barnhill RC, Beyer C, Cash KA. Evaluation of the relative contributions of various structures in chronic low back pain. Pain physician. 2001 Oct;4(4):308-16.

4. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European journal of pain. 2006 May;10(4):287-.

5. Van Kleef M, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, Mekhail N. 12. Pain originating from the lumbar facet joints. Pain Practice. 2010 Sep;10(5):459-69.

6. Bogduk N. International Spinal Injection Society Guidelines for the Performance of Spinal Injection Procedures.: Part 1: Zygapophysial Joint Blocks. The Clinical journal of pain. 1997 Dec 1;13(4):286-92. 

7. Cramer GD, Fournier JT, Henderson C. Zygapophysial joint changes following spinal fixation. InInternational Conference on Spinal Manipulation; 2000 September 21-23; Minneapolis. Brookline: Foundation for Chiropractic Education and Research 2000 (pp. 85-87). 

8. Hides J, Stanton W, McMahon S, Sims K, Richardson C. Effect of stabilization training on multifidus muscle cross-sectional area among young elite cricketers with low back pain. Journal of orthopedic & sports physical therapy. 2008 Mar;38(3):101-8.