Healthy Life : Articular Facet Joint Problem (909)

Healthy Life : Articular Facet Joint Problem

蘇鎮邦：舒整物理治療師 (Manipulative Physiotherapist) 人類工程師 (Ergonomist)

Discogenic protrusion is a very common condition of back pain. It is usually caused by people lifting heavy objects without bending the knees. As the back straightens up, any twisting movements will put a huge stress on the disc and tearing the annulus fibrosus that keeps the integrity of the nucleus pulposus. When the nucleus pulposus is subjected to further pressure, it bulges out and compresses on the spinal nerves in the intervertebral foramen (see diagram). At the time, people may feel a pinch or twinge. They may not take any notice. As repeated stress causes more jelly coming out, it will reach the breaking point. A relatively minor stress such as a sneeze, a cough or bending down to pick up a piece of paper will cause severe pain in the back. Then, people will unable to move for a length of time e.g. half an hour to an hour. This can cause pain down the leg i.e. sciatica. In the neck or cervical spine, and it can cause pain down the arm i.e. radiculopathy.

Therefore, a lot of back pain conditions have insidious onsets. It may surface a day or two after the minor incidence. Sometimes, it can even be one to two weeks or months. By then, people will not be able to associate the incidence with the present back pain. If patients cannot tell you the cause of the problem, it will be very hard to advise the patient how to prevent further incidents. If any back pain that persists for more than 3-4 days, patients should consult their physiotherapists.

However, articular facet joint problem is very different to discogenic protrusion in cause and symptoms. It is usually caused by sudden awkward or unnatural movement. Pain will be very severe and the patient can definitely remember the incident and thus the cause of the problem. It can stop the patient from moving for a length of time too. It is common to get worse the next morning after rest or sleep.

Acute wry neck is one of the common conditions. However, it can happen in the thoracic and lumbar spine as well. Joint locking is a common sign. As the pain sensitive tissues around the joint are being pinched, severe pain and muscle spasm will cause the locking. It is unlikely to cause referred pain down the arms, rib cage or legs in respective areas. Usually, right side problem will cause pain on rotation and side bending to the right. Also, bending back will be more limiting than bending forward as the former movement will cause compression on the joint surface.

This is the condition which is suitable for Grade V Manipulation. It is a very quick mobilisation technique that cause the articular facet joint to open and close allowing the pinged tissue to be released. Most of the time, there is a clicking sound. The recover or relief of pain can be dramatic and impressive on the patient. However, this is definitely a contraindication for the treatment of discogenic problems.

（Diagram 1）Superior Articular Facet and Annulus fibrosus