Facet Joint Sprain (Lumbar)

Injuries > Lower Back > Facet Joint Sprain

(Also known as Facet Joint Pain, Zygapophyseal Joint Sprain, Sprained Facet Joint, Facet Joint Dysfunction, Facet Joint Pain, Apophyseal Joint Sprain, Back Sprain)

What is a facet joint sprain?

The spine comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the discs centrally (figure 1). These joints are designed to support body weight and enable spinal movement.

Each facet joint comprises of smooth cartilage which lies between the bony joint surfaces cushioning the impact of one bone on another. Strong connective tissue also wraps around the bony ends providing support to the joint.

During certain movements of the spine, stretching or compressive forces are placed on the facet joint. If these forces are excessive and beyond what the facet joint can withstand, injury to the facet joint may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. This condition is known as a facet joint sprain.

Causes of a facet joint sprain

Facet joint sprains typically occur during excessive bending, lifting or twisting movements. They may occur traumatically or due to repetitive or prolonged forces.

Signs and symptoms of a facet joint sprain

Patients with a facet joint sprain may experience a sudden onset of back pain during the causative activity. However, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms are typically felt on one side of the spine and muscle spasm may be experienced around the affected joint. Occasionally pain may be referred into the buttocks or lower limb on the affected side. Symptoms are generally exacerbated with activities that involve twisting, lifting, arching backwards, bending forwards or sideways or sitting for prolonged periods of time.

Diagnosis of a facet joint sprain

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a facet joint sprain. Investigations such as an MRI or CT scan may be required to confirm diagnosis.

Treatment for a facet joint sprain

Most patients with a facet joint sprain heal quickly and have a full recovery with an appropriate physiotherapy program. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once this is achieved a gradual return to these activities is indicated provided there is no increase in symptoms. It is also important to perform early movement and strength exercises to prevent stiffness and weakness from developing and to ensure the back is functioning correctly.

Generally, sitting for prolonged periods should be avoided. However, if inevitable, optimal sitting posture is important to minimize stress on the facet joint. If you sit slouched, your lower back goes into its maximal bend (similar to standing and touching your toes) this may aggravate a facet joint. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your bottom in the back of the chair and a lumbar support (or a pillow / rolled up towel) in the small of your back. Your shoulders should be back and your chin should be tucked in slightly (figure 2).

Prognosis of a facet joint sprain

The recovery time for a facet joint sprain may vary from patient to patient depending on compliance with physiotherapy. With ideal treatment, patients may be pain free in as little as several days, although typically this may take 2 – 3 weeks. It is important to note, however, that injured tissue takes approximately six weeks to restore the majority of its strength in ideal healing conditions. Care must therefore be taken when returning to activity during this period.

Physiotherapy for a facet joint sprain

Physiotherapy for a facet joint sprain can hasten the healing process and may involve:

• soft tissue massage
• electrotherapy (e.g. ultrasound)
• mobilization
• dry needling
• postural taping
• the use of a back brace
• the use of a lumbar roll for sitting
• education
• activity modification advice
• biomechanical correction
• ergonomic advice
• clinical Pilates
• hydrotherapy
• exercises to improve flexibility, strength, posture and core stability
• a gradual return to activity program

Contributing factors to the development of a facet joint sprain

There are several factors that may contribute to the development of a facet joint sprain. These factors need to be assessed and corrected with direction from a physiotherapist and may include:

• poor posture
• lumbar spine stiffness
• a sedentary lifestyle
• poor core stability
• muscle weakness or tightness
• inappropriate lifting technique
• being overweight
• a lifestyle involving large amounts of sitting, bending or lifting

Other intervention for a facet joint sprain

Despite appropriate physiotherapy management, a small percentage of facet joint sprains fail to improve and may require other intervention. This may include pharmaceutical intervention, investigations such as an X-ray, CT scan or MRI, or assessment from a specialist. A corticosteroid injection into the facet joint may sometimes be used to help alleviate symptoms. The treating physiotherapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically.

Exercises for a facet joint sprain

The following exercises are commonly prescribed to patients with a facet joint sprain. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3-4 times daily and only provided they do not cause or increase symptoms.

Elbow Prop 

Begin lying on your front and slowly move up onto your elbows provided it does not increase your symptoms (figure 2). Hold for 5 seconds and then return to lying flat. Repeat 10 times.

Figure 2 – Elbow Prop

Rotation in Lying

Begin this exercise lying on your back as demonstrated (figure 3). Slowly take your knees from side to side as far as possible and comfortable provided there is no increase in symptoms. Repeat 10 times.

Figure 3 – Rotation in Lying

Physiotherapy products for a facet joint sprain

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:

1. Lumbar Supports
2. Back Braces
3. Ice Packs or Heat Packs
4. McKenzie Treat Your Own Back Books

To purchase a physiotherapy product for a facet joint sprain, click on one of the above links or visit the PhysioAdvisor Shop.

Find a Physio for a facet joint sprain

Find a physiotherapist in your local area who can treat a facet joint sprain.

Other Exercises

View more lower back flexibility exercises.

View lower back strengthening exercises.

View basic Pilates exercises to improve your posture and core stability.

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