The Lonely Facet Joints
The often forgotten spinal structure in mechanical low back pain
An Anatomical Review & Sport Based Application
I recently visited my favorite sporting good store and could not help but notice the latest trend of bright florescent sneakers and apparel filling the displays. To make a parallel comparison with the Chiropractic and Physiotherapy world, the latest trends seem to be functional movement screens, myofascial release techniques and colorful proprioceptive tape that fill the practitioners tool box, all to better facilitate health and performance in their patients. While the muscles and surrounding fascia seem to share most the limelight, the lonely spinal facet joints (synonymous with Zygapophyseal, apophyseal and Z joint) seem to be left behind and forgotten about.
Has this become the latest trend, the latest fad that will come and go like everything else with time? Or, like the fancy bell-bottoms and plaid pants from the 60’s, will the facet joints reemerge into the conversation when discussing mechanical low back pain? Below is a summary of the anatomical features of the spinal facet joints, their function and landmark research.
The Anatomical Features of the Spinal Facet Joints
The lumbar facet joints are orientated in a postero-lateral fashion connecting the vertebral arch of one vertebra to the arch of the adjacent vertebra. As true synovial joints, each facet joint contains a distinct joint space capable of accommodating between 1 and 1.5 ml of fluid (1).
The basic anatomical unit of the spine, often referred to as the three-joint complex, consists of the paired Facet joints and the intervertebral disc, together, these joints function to support and stabilize the spine, and prevent injury by limiting motion in all planes of movement(2)
Up to 80% of cases of LBP and sciatica are due to referred pain from Lumbar facet joint pathology(3)
Lumbar facet joints are richly innervated with encapsulated Ruffini-type endings, pacinian corpuscles and free nerve endings. The presence of mechanosensitive neurons suggests that facet joints contain nociceptive information (Pain) as well has a proprioceptive function (4).
The Golf Low Back Pain Epidemic
Speaking from a golf professional standpoint, the number one played sport in Canada with almost four million people participating in the sport each year (5) contributes greatly to the low back pain epidemic. During the down swing and follow through phase of a right-handed golfer the trail side facet joints take on comparable compression to collage football linemen when hitting a blocking sled (6). In golf tour professionals, it is evident on plain film X-rays that degenerative changes occur in the right facet joints, in the right-handed golfer from such compressive forces (7). In response to the repetitive strain and inflammation being placed on the synovial facet joints during the golf swing, the spinal nerve may become compromised, leading to spasm of the muscle. It is easy to see why many practitioners focus solely on the surrounding tissue since the Multifidus muscle, interspinous muscle and ligament, and periosteum of the neural arch all share the same innervation with the facet joints (medial branch of the posterior primary rami).
In regards to evidence based practice, should we abandon the current thinking of “muscle before joint”. Should we seek out more of a functional neurology approach to mechanical low back pain especially in athletics? Like all popular trends, our approach will be forever evolving just like the bright pink, blue and purple’s that fill the sporting good shelves. These present-day styles will all come and go. However, I still really like those plaid pants.
References:
- Ahia LH, Garzon S: Structure on the capsular ligaments of the facet joints. Ann Anat 1993; 175:185–8
- Borenstein D: Does osteoarthritis of the lumbar spine cause chronic low back pain? Curr Pain Headache Rep 2004; 8:512–7
- Manchikanti L: The growth of interventional pain management in the new millennium: A critical analysis of utilization in the Medicare population. Pain Physician 2004; 7:465–82
- Cavanaugh JM, Ozaktay AC, Yamashita HT, King AI: Lumbar facet pain: Biomechanics, neuroanatomy and neurophysiology. J Biomechanics 1996; 29: 1117–29)
- Conducted by NAVICOM on behalf of the National Allied Golf Associations FINDINGS REPORT (Published September 12, 2012)
- Gatt JC, Hosea TM, Palumbo RC. Impact loading of the lumbar spine during football blocking. Am J Sports Med 1997;25(3):317-21.
- Sugaya H, Tsuchiya A, Moriya H, Morgan DA, Banks SA. (1999). Low back injury in elite and professional golfers: An epidemiologic and radiographic study. Science and Golf3: Farrally MR, Cochran AJ (Eds). Human Kinetics: Champaign, P: 83-91, 1999.