Lumbar Facet Sprains

No matter who you are, sustaining an injury to your lumbar spine also known as your lower back is always frightening and concerning. Our immediate reaction is to assume we have “blown a disc” and that our back is never going to be the same. However, despite our initial thoughts, multiple tissues can elicit a pain response in our lumbar spine region. In this blog post, we are going to discuss lumbar facet sprains. What they are, what causes injury to them, signs and symptoms, treatment, management and prognosis.

First of all, what is a facet joint? These joints are the connection pillars of the entire spine, they join together and allow for multi directional movements of the spine. Flexion, extension, twisting and sidebending. The joints provide limitations on how far each of the vertebrae can move when performing these movements, otherwise, they would have no end range. Each facet has a slightly different angle than the other which allows for all different directions of movement.
They are strong, versatile and resilient joints but just like any other joint in the body these can be sprained and irritated which causes inflammation, pain and muscular guarding which can all be quite concerning for a patient.

Lumbar facet sprains tend to mimic signs and symptoms of lumbar disc bulges, however, there are a few certain aspects which can help us decipher the tissue that’s causing your pain.

• Typically, immediate onset of pain
• Sharp local pain when attempting to move
• Warmth around the lower back area
• Muscular guarding of erector spinae and quadratus lumborum muscles
• A significant lack of movement into lumbar spine extension and sidebending

Probably one of the most frustrating things about facet sprains, in general, is that they can be caused by the simplest and smallest movements. A particular activity or task you do every day could one day be the cause of the dreaded facet sprain. Typically there have been multiple factors or activities that have led to the facet becoming inflamed and irritated, however, it’s the specific movement or activity we do that is the onset of pain and therefore what we believe as patients is the only cause.

• Poor lifting techniques
• Sitting on the couch awkwardly
• Poor sleeping positions Sleeping
• Rotational movement such as reaching for something in the back seat of the car
• Sport
• Lack of movement

Typically lumbar facet sprains are diagnosed by a combination of a case history consultation and some orthopaedic tests. The most common test is called quadrant or kemps. In this test your practitioner will attempt to move your affected facet joint to its most maximal compression (extension and sidebending). If this joint is inflamed and irritated this will cause a sudden familiar increase in pain (typically sharp). It is also common that the patient is unable to perform this movement due to muscular guarding that is caused by the injury.

There are multiple treatment options for assisting and relieving facet joint sprains. It is important to know that the body has to undergo its natural inflammatory process which can take up to 72 hours post-injury.
During the initial inflammatory phase treatment options include:

• A heat pack or ice pack
• Gentle movement such as short walks, leg rocks side to side, thread the needle, cat/camels

Once the inflammatory phase has reduced and patient movement has improved, treatment options include:

• Joint articulation of the lumbar spine to improve lumbar mobility.
• HVLA (adjustment) techniques to the affected joint.
• Stretching techniques to associated musculature that may have been spasmed during the inflammatory phase.
• Treatment to areas affected above and below the facet joint as sustaining an injury alters function elsewhere in the body.
• Rehabilitation exercises to continue improving mobility along with strengthening particular musculature which may have been a predisposing factor to your
• facet joint injury.

The prognosis of a facet joint sprain can vary from anywhere between 1-3 weeks. This is quite a broad range as everyone responds differently. Not only this but facet joints are quite easy to irritate once they are already inflamed and under stress. Simple things such as standing up too quickly, reaching for something or sleeping in the wrong position can stir up your facet sprain. This is why it is so important to listen to your healthcare practitioner and follow their advice accordingly in an attempt to resolve your injury as quickly and efficiently as possible.

Prevention is better than cure. There are multiple things that we can do in an attempt to avoid sustaining a facet joint sprain.

• Staying as active as possible is essential. Allowing our body to move freely and for our joints to be taken through all of their available motions reduces the joints sensitivity to be sprained and irritated. If we are sedentary and lack movement then our joints aren’t taken through ranges of motion and therefore are more prone to become irritated if they are exposed to an unfamiliar movement.
• Regular stretching and mobility allows for our joints to maintain their full range of motion.
• Strengthening our lower back and surrounding musculature.
• Making sure when lifting objects, using your legs to lift rather than pulling from your lower back.

Exercises prescribed for facet joint injuries aim at improving lumbar mobility along with lengthening muscular tissue surrounding the joint.

Cat/camel: this mobility exercise encourages lumbar flexion/extension movement. On all fours, try and make your back as flat as possible like a tabletop. With a gentle controlled movement rocking your pelvis forward to increase the arch in your lumbar spine “cat” and then rolling your pelvis in the opposite direction to raise like a “camel”. Perform this movement twice daily, completing three sets with ten repetitions.

Thread the needle: this mobility exercise encourages lumbar rotation/sidebending whilst also stretching some of your lower back muscles. On all fours begin by bringing one arm up to the roof, take a deep breath in and on the exhale slowly reach your arm through to the opposite side running your hand along the floor. Hold this position for 5 seconds and then move back to the original position. Perform this movement twice daily, completing three sets with ten repetition.

Lumbar rocks: A great exercise to add rotation through the pelvis and lumbar area in an attempt to increase motion. Laying flat on your back with your knees bent. Slowly and controlled, contract your gluteal muscles and rock your knees side to side ensuring you’re controlling the movement. If you feel pain then reduce the size of the rock. Perform this movement twice daily, completing three sets with ten repetitions.

More often or not if you have sustained a facet joint sprain to your lower back there is no need to present to your GP or local hospital. The symptoms and cause is typically musculoskeletal and therefore can be managed by your healthcare practitioner. However, if your presentation is not progressing as expected your practitioner will not hesitate to refer you to your GP for their opinion or diagnostic imaging.

**Note: if you experience pins and needles at the base of your sitting bone or any changes in your bowel or bladder after sustaining an injury to your lower back, please present to your local hospital.