Can’t stand up straight without wincing in pain? Neck so stiff you can barely move it? Is twisting to get in or out of the car an awkward, painful dance?
Neck and back pain can be annoying. It might be a sign of a simple muscle spasm or ligament strain, but persistent neck or back pain can also be caused by a more serious condition, such as arthritis of the facet joints.
What are facets?
When you hear “joints,” you might think of your knee, elbow, jaw, or hip. But your spine contains many joints as well. The spine is made up of bones called vertebrae that are separated by disks. Each vertebra has two sets of facet joints. These are synovial joints located on either side of the posterior process of the vertebral bodies.
These facet joints link the vertebral bodies together, providing stability, support, and mobility to the spine. These joints allow the spine to perform forward flexion, extension, and twisting motions. Like any other joint, the facet joints have cartilage, which can become worn and thin, preventing normal motion of the spine.
Cartilage can break down with injury or age. The cartilage in the facet joints wears away over time, becoming thinner and less supportive. Disks can slip or bone spurs can grow as the bone attempts to adjust to less support from the cartilage. Inflammation can occur as osteoarthritis develops in the facet joints. Degeneration of the facet joints can lead to pain, stiffness, and even pressure on the nerves of the spinal cord.
There are many names for this pattern of breakdown, including:
- degenerative facet joints
- facet arthritis
- facet disease
- facet hypertrophy
- facet joint syndrome
Vertebrae are usually separated into several groupings. Cervical vertebrae are the neck vertebrae. Thoracic vertebrae make up the mid-back, and lumbar vertebrae make up the lower back. The facet joints of the cervical spine can develop cervical spondylosis, which is arthritis of the neck joints. More than 85 percent of people over age 60 have some degree of this condition, according to the American Academy of Orthopaedic Surgeons.
A history of neck injuries increases your risk for developing cervical facet arthritis. Likewise, a job with repetitive neck motions can increase your risk. Genetics and smoking can increase your risk as well. Bone spurs are a common hallmark of this condition.
Arthritis and degeneration of the facet joints causes abnormal movement of the vertebral bodies and results in the development of bone spurs. This results in a host of problems that cause painful symptoms. If the cervical facet joints are affected, the following symptoms can occur:
- neck pain and stiffness, which often worsens with activity
- grinding sound, as bones scrape against each other with movement of the neck
- muscle spasms in the neck and shoulders
- pain that is at its most intense first thing in the morning and then again at the end of the day
- pain that radiates from the neck into the shoulders and between the shoulder blades
- stinging pain that travels down the arms
Lower back pain
Low back pain is a very common problem with many potential causes. Degeneration of the facet joints can lead to a spiral of problems that cause serious symptoms such as weakness. As we age and the cartilage between our joints loses water and volume, more pressure is put on each facet joint. In the lumbar spine (the lower back), this can result in arthritis of the lumbar facet joints.
To make up for the lost cartilage, new bone may begin to grow. This causes bone spurs that can pinch nerves. Lumbar facet arthritis can lead to pain and stiffness in the back. If you have this condition, you may find yourself inclined to lean forward often, as this creates more space between the joints and removes pressure on pinched nerves.
Other symptoms of lumbar facet arthritis include:
- pain after resting or sleeping
- pain after bending your upper body backward or to one side
- pain that feels centered in your lower back, but may extend into your buttocks and thighs
- bone spurs that cause tingling and stinging in your back and limbs
Nerves in the spinal cord or the nerve roots may become pinched as a result of joint damage. The spinal canal can also become smaller, leaving less room for nerves to pass through the spinal column. Pressure on nerves can result in more profound symptoms, including:
- numbness and weakness in the arms, hands, and fingers (cervical facet joints)
- trouble walking, loss of balance, or weakness in the hands or legs (cervical, thoracic, or lumbar joints)
- burning pain, tingling, or numbness in the buttocks or legs, also called sciatica (lumbar facet joints)
Some factors increase your risk for developing facet arthritis and the aches and pains associated with it. They include:
Having a joint problem in your hand or foot doesn’t mean you’ll develop arthritis in your spine. However, joints that are not aligned due to inflammatory arthritis, injury, or subsequent arthritis can lead to greater wear and tear or damage to other joints. That’s why having osteoarthritis somewhere in your body can ultimately lead to arthritis in the joints of your spine.
These fluid-filled sacs develop along the spine. As the spine’s joints wear down, they release extra fluid. A sac can develop to catch this fluid, and multiple cysts can develop along the spine. Cysts are rarely bothersome until they start pressing on nerves.
Changes in disk height
As the space between the vertebral bodies shrinks, joint irritation and inflammation as well as pressure on nerves can increase. This shrinking space can cause additional wear and tear on the joints and eventually lead to or exacerbate existing facet arthritis.
Being overweight or dealing with obesity places additional stress on your joints. This extra pressure can lead to joint damage and arthritis.
Arthritis of all types becomes more common as you get older.
Men are more likely to develop osteoarthritis of the spine under the age of 45. Over the age of 45, women are more likely to develop it.
To reach a diagnosis, your doctor may conduct several types of tests, including:
Complete health history
Before a single blood test or imaging test is ordered, your doctor will likely want to learn about your symptoms. They’ll also want a complete health history, including information on problems or conditions you experience that may be unrelated to joint pain. Be sure to provide your doctor with details about when the pain is at its worst, what makes it better, and how long you’ve been experiencing it.
Once a written exam is complete, your doctor may perform a full physical exam. This could include checking your body for signs of damage or disease. They may ask you to move several limbs to examine your range of motion, muscle strength, and reflexes.
Your doctor may request an X-ray, CT scan, or MRI to look for possible explanations for your symptoms. These tests allow your doctor to view the muscles and soft tissues around your back with greater detail.
Locating the exact source of your pain can help your doctor differentiate between many potential causes. Injecting an anesthetic into a particular joint is one method they may try. If the anesthetic numbs the joint and your pain goes away, your doctor knows it’s facet arthritis. If the pain remains, your doctor will continue their search. This procedure is also known as a facet block.
Doctors primarily treat facet arthritis with nonsurgical options. Recovery from the surgical options are sometimes difficult. Talk with your doctor to understand all of your options and weigh the pros and cons of each one.
The most common treatments for facet arthritis can often be used together for maximum benefit. These treatments include:
- Rest. For some, resting and reducing the use of the spine may help ease symptoms.
- Supports in bed. Specialty pillows and braces can make sleeping more comfortable. These devices may also reduce the pain you feel in the morning.
- Mild pain relievers. Pain relievers such as aspirin (Bayer) and nonsteroidal anti-inflammatory drugs (NSAIDs) may ease pain and relax muscles enough to end symptoms for brief periods of time.
- Muscle relaxers. If the pain is severe, prescription-strength medication can calm muscles and ease pain and tightness.
- Physical therapy. A physical therapist can teach you sitting, stretching, and sleeping exercises that relieve pain and prevent sore muscles and joints. As the arthritis worsens, a physical therapist can also help you maintain strength and stamina.
If other treatments aren’t successful, surgery may be an option. Many of these procedures aren’t highly invasive, so recovery should be less time-consuming than it is for other forms of surgery. Types of surgery for facet arthritis include:
- Radiofrequency nerve ablation. During this procedure, radiofrequency waves (concentrated heat) are used to destroy nerves of the facet joints that send signals of pain to the brain.
See your doctor
Neck and back pain can be debilitating, but these conditions can be treated with medications, physical therapy, steroid injections, and sometimes surgery. It’s important to see your doctor to determine the cause of your discomfort. Tests may be necessary to ensure that other serious conditions are not causing your pain. The following conditions cause symptoms similar to facet arthritis and should be ruled out:
If your general practitioner believes you have facet arthritis, they may recommend that you see a specialist. A rheumatologist will focus on diseases and conditions that affect the bones, muscles, and joints. If you need surgery or more invasive treatment techniques, an appointment with an orthopedist may be necessary as well.