Introduction and background
Arthritis of the lumbar facet joints can be a source of significant low back pain as like other joints in the body that are covered with articular cartilage, the lumbar facet joints can also be affected by arthritis. Facet joint arthritis develops slowly over a long period of time. This is partly because spinal degeneration in later life is the main cause of facet joint arthritis.
Understanding lumbar vertebrae
You must know that the human spine is made up of 24 different spinal bones, called vertebrae. Vertebrae are stacked on top of one another to create the spinal column. The spinal column gives the body its form. It is the body’s main upright support. The vertebrae of your spinal column can be divided into several categories with respect to their location such as:
Cervical vertebrae (the vertebra of your neck
Thoracic vertebrae (the vertebra of spine, located just behind your chest / thorax)
Lumbar vertebrae (the vertebra of spine, located just behind your abdomen)
Understanding facet joints
Quite interestingly, between the vertebrae of each spinal segment are two facet joints. The facet joints are located on the back of the spinal column. There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made of small, bony knobs that line up along the back of the spine. Where these knobs meet, they form a joint that connects the two] vertebrae. The alignment of the facet joints of the lumbar spine allows freedom of movement as you bend forward and back.
Causes of lumbar arthritis
In a normal person without arthritis, the facet joints fit together snugly and glide smoothly, without pressure. If pressure builds where the joint meets, the cartilage on the joint surfaces wears off, or erodes. Facet joints can also become arthritic due to a back injury earlier in life. Fractures, torn ligaments and disc problems can all cause abnormal movement and alignment, putting extra stress on the surfaces of the facet joints. The body responds to this extra pressure by developing bone spurs. As the spurs form around the edges of the facet joints, the joints become enlarged. This is called hypertrophy. Eventually, the joint surfaces become arthritic. When the articular cartilage degenerates, or wears away, the bone underneath is uncovered and rubs against bone. The joint becomes inflamed, swollen, and painful.
Signs and symptoms of lumbar arthritis
Pain from facet joint arthritis is usually worse after resting or sleeping. Also, bending the trunk sideways or backward usually produces pain on the same side as the arthritic facet joint. Pain may also be felt in the center of the low back and can spread into one or both buttocks. Sometimes the pain spreads into the thighs, but it rarely goes below the knee. Numbness and tingling, the symptoms of nerve compression, are usually not felt because facet arthritis generally causes only mechanical pain. Mechanical pain comes from abnormal movement in the spine.
Treatment of lumbar arthritis
Medical therapy: Facet joint arthritis is mainly treated non-surgically. At first, doctors may prescribe a short period of rest, one to two days at most, to calm inflammation and pain. Patients may find added relief by curling up to sleep on a firm mattress or by lying back with their knees bent and supported. Your doctor may prescribe anti-inflammatory medication, such as a non-steroidal anti-inflammatory drug (NSAID) or aspirin. Muscle relaxants are occasionally used to calm muscles that are in spasm. Oral steroid medicine in tapering dosages may also be prescribed for pain. However, unfortunately, this mode of therapy takes much longer time to provide symptoms relief, if any. It also has a lot of side effects.
Surgery: People with facet joint arthritis rarely need surgery. However, facet joint arthritis is a primary source of chronic low back pain about 15 percent of the time. After trying other types of treatment, some of these patients may eventually require surgery but only as a “last option”.
Herbal therapy: Taking safe herbal supplements such as Provailen has been found to be of great help for providing symptom relief (e.g. pain) and reducing facet joint inflammation. Also, unlike medical drug therapy, Provailen is free from side effects, can be used for long term and is very affordable for everyone.