Facet syndrome is a condition of the small joints in the spine (called facets) characterized by pain and inflammation around the joint. Shaped like miniature hooks, facets are about the same size as the joints in your hands. They connect each vertebra in your spine to its neighbors, help you bend smoothly, and prevent your vertebrae from slipping back and forth. Facets are lined with cartilage to allow the bones to glide freely over each other. Injury and arthritis can damage the cartilage, leading to stiffness, pain, and inflammation.

Causes of Facet Syndrome
Twisting injuries can tear the cartilage around the joint much the same way knee cartilage can be torn. The torn portion of cartilage may then form a barrier in the joint, limiting motion and causing pain when pressure is applied to the joint. Facet joints are vulnerable to arthritis, which has been caused by previous injury to the joints or by the normal wear and tear of aging. Discs that have degenerated also can cause irritation around the facet joints. Motions that require repeated extensions (bending over with straight legs, driving with your seat far from the wheel, or standing in one position too long) will overload the facet joints and cause inflammation, swelling and pain.

Diagnosis
Your doctor may order one or more special tests to help confirm your diagnosis, rule out other problems, and pinpoint the source of your back pain.

X-rays show the general condition of your vertebrae (bones), and are very helpful in determining the cause of pain. Although x-rays cannot reveal a ruptured disc, for instance, they may reveal a narrowed disc space which can be an indication of trouble in that area of the spine.

MRIs (magnetic resonance imaging) and CTs (computerized tomography) produce detailed computer images of soft tissues and bones. MRIs are especially beneficial for the study of soft-tissue abnormalities such as disc degeneration, protrusion, or rupture. CT scans give a cross-section view of the spine and can show a bulging or ruptured disc.

EMGs (electromyography) measure the electrical activity of your muscles’ contractions. They detect nerve or muscle irritation and damage.

Bone scans can reveal abnormal bone activity.

Treatment
Initial treatment is conservative and usually includes up to four weeks of bedrest followed by a gradual return to normal activities. During this time, you may receive medications such as anti-inflammatory agents, muscle relaxants, and physical therapy. For many, this is sufficient to treat the symptoms, however for those whom conservative therapy has not worked, spinal injection therapy may be appropriate.

• Facet Injections: Facet Injections are injections of a potent cortisone-type drug and a Novocaine®-like anesthetic directly into the facet joints. By getting the cortisone to the specific site of inflammation, better pain control and treatment may be achieved. The addition of anesthetic with cortisone may give relief. The procedure may be done under special x-ray control to help place the medication more precisely into the problem joint. To avoid discomfort, a local anesthetic is used to numb the skin around the area of the injection. Facet injections may provide long lasting pain relief.
• Physical Therapy: Once the pain and inflammation are under control, it is important to restore motion and take stress off of the facet joint. Tight muscles often add considerably to the pain syndrome and if not corrected, the inflammation may return.
  Physical therapy offers various methods to keep joints flexible and help stretch and strengthen the muscles. Tight muscles are treated with deep heat, electrical stimulation, and muscle-stretching exercises. Aquatic therapy is useful, particularly in the early stage of treatment, because the buoyancy of the water makes it easier to move without stress on the sensitive joints. The water also offers steady resistance against the body so that muscle strain is avoided and flexibility is increased. Exercises to strengthen muscles can provide a stabilizing effect on your spine. Techniques to help build a strong spine and the basics of good body mechanics (the way you move your body and back) are important in long-range care and prevention of future back problems.

What else can be done?

Avoid lifting with your back bent; keep your back straight and lift with your legs. A proper diet is important because excess weight around the abdomen arches the back and leads to even more stress on the facet joints.