Facet Joint Problems

[yssqeyod]

Hi

I started getting on and off pains in my ankles wehn running last summer. and after seeing various phsyios etc who were working on my ankles it turns out it was coming from my back as a facet joint was irritating one of my nerves hence a bit of a numby feeling running down my shin into the top pf my foot now and again. Went to see 2 different chiropractors in the last few months and they heavey handed techniques really inflamed the pain going down my leg - they often said it will for the first few sessions but it didn't get any better so stopped going to see them. In the mean time as i've been resting loads i feel my mobility has gone in my lower back, core stability has gone and im geeting regular cluncks in my lwoer back when doing certian movements - the big clunks sent my back into spams but they little clicks are not too back.

Had an MRI scan and showed a bit of wear and tear on my facet joints and have a very minor disk protrusion at L3/L4.

Recently managaged to fine a decent osteopath who thinks my problem is coming from locking facet joints which is irritating the sciatic nerve a little. They said the slight buldge at L3//$ is not causing me any problems as i work have sharp opains runnign down my leg + nerves running into the foot are from L4/5 and S1 and not L3. Also read that most of the population will have a slight prolasped disk that will never cause them any problems.

Can facet joint dysfucntion cause neural irritation and is this the kind of thing that can be put 100% right?

after one month of working on core stabalising muscles and3 sessions with a phsyio and now 2 working with an osteopath (very impressed with him so far) thebig clunks i was geting have died right down but still getting littleclicks that sometimes inflame my nerves

after a few months of the facet joint problem in lower back i also started to get a few small clicks problems in my upper back - the experts i have seen all said this is a knock on affect from whats going on in the lower back and to be honest these have started to diw down also as mobility in the lower back has improved

my only worry is that the small clciks wont ever go away and wont be able to do distance running seriously again

any views?

 

[Lil Dude Eats Tinkerbell]

Sorry - only just seen your email.

How are you getting on with the osteopath?

Andrew.

 

[wellwisher]

Yes he seems to know what my problem is ie facet joint dysfunction. Due to the fact I seen quite a few chiropractors before christmas that totally inflammed my joints he thinks I've probably been over treated and have got a hypermobile joint as a result which keeps clicking during certain movments. The MRI scan I have shows mild facet joint hypothrophy and a minor posterior disk protrusion at L3/L4 (no neural compression seen). we do not think that the disk protursion is causing my problems as no sharp pains going down my leg + he didn't seem to think L3 would affect the nerves going down the sciatic path , down my shin and into my foot. These are not sharpe pains but more of a sensation with av slight feeling of numbness when it comes on - it usually comes on after a get a clunk in my lowerr bacl. He seems to think my problem is coming from L4/5 as this is the joint that is very tight and keeps clicking. My main question is can facet joint problems cuase route nerve irritation?

 

[Bitchy Blonde SUSPENDED.]

Nerve Root Irritation (NRI) is unlikely to be caused by a facet joint problem, although one could argue that it's not impossible due to their proximity. It's not something that can proved is disproved, but were fairly sure that they can cause reffered pain.

A disc injury is usually regarded as the main or even sole cause of nerve root irritation. For the disc to do this there wouldn't necessarily be any great compression of the nerve root. The nucleous of the disc contains substances (incl. substance P) that cause inflammation if it has actually prolapsed. Also it's worth bearing in mind that MRI's as far as I know are only taken when lying down, so there is actually no weight bearing on the discs at the time. Whereas there is when you're upright.

Hope that helps - Andrew.

 

[LQ_MASSAGE]

Thanks for the reply. I went to see Dr John Tanner last week. He looked at my scan and could see a minor disk protrusion but didn;t think it was anything major (at the moment). He thought that this could irritate my nerves with certain movements but as its not constant and not a sharpe stabing pain its irritation rather than constant compression. Still i get quite a few clinks and clunks in my lower lumber which seems to irritate things and cuase the muscles in my back to lock up if its a heavy contact - often the sensations going down my leg come on after a clunk which is why certain professionals have treated my problem as a facet joint dysfunction. It sounds like its a combination of them both. are there any treatments i should stay clear of that could make a minor disk protrusion worse - i have heavy manipulation inflamed my syptoms in the past whese as the osteopath im seeing now is doing a combination of mobilisation - and the odd lightly manipulation. im doing shed loads of core stability work on my deep stabalisers but nothing on my back as my back seems to get very tight after any back exercises!

 

[ModAdministrator]

I often use some western acupuncture before osteopathic treatment when an area is particularly reactive or just chronic but it depends on the individual. Needling first seems to reduce local muscle tone/spasm to loosen and calm down the whole area.

There are other osteopaths about that use this approach.

It may well be that it's healing as fast as it can and that you are already doing as much as you can to help.

Andrew.

 

[prashant4044]

can an epidural be used to calm down facet joint inflamation rather than facet joint injections? the joints in my lower back have been stinging for a good few days now and lumber flexion ability has drastically reduced as a resullt. i know rehab and exercise is the long term solution (which i have been doing) but tried swimming and 20 mins on the exericse back last week to try and get some movement but it really inflamed my lower back! my friend who was diagnosed with facet joint problems years ago had an epidural to calm the joints down but i was under the impression epidurals were only used for route nerve irritation rather than facet joint inflamation!

either way an epidural sounds a less nasty proceedure than facet joint injections!

 

[Joe Wait ?]

Hi Iant,
I've just been reading your discussions with great interest and I'm delighted to hear that you are slowly on the mend. I would caution against using epidural injections if you can as from my experience with clients, the body can see this as an assault on it, which can slow the healing process down. I had a client with chronic problems for seven years and she was doing really well with her core stability training and her pain management,then the pain clinic suggested an epidural which set her back six months. My feeling is that while it may settle the pain temporarily it won't cure the underlying problem.

It sounds like your osteopath is getting you to do the right thing by working on trans abs and mutlifidis to help stabilise the spine at a segmental level. It may also be worthwhile looking at the length and strength of your psoas and some of your hip deep muscles to see if there is imbalance around there. (I'm mindful of the fact that you initially noticed the injury in your legs running, so there will be a longstanding imbalance there that will need to be addressed, especially to allow you back to activities such as swimming and exercise biking)

The body is like a puzzle,if there is some element out of position or alignment the body will do it's best to re-dress the imbalance elsewhere. When you train/exercise on top of this imbalance it increases the loading and starin resulting in injury.
I appreciate it is frustrating, (I left working in the NHS as a physio after a severe nerve root entrapment in my left arm) and you are on the right track.
I try and get my clients to see pain and injury as your bodies way to communicate with us. This is an opportunity to get yourself balanced and aligned. The mind and head move at a much faster speed than the body. Take time for it catch up.
Stay in touch- Rachael

 

[soby H]

thanks for the advice

The problem for me has always been finding someone who looks at the whole picture and knows about back problems. Im quite big on biomechanics as through years of running I've had quite a few injuries from muscle imbalances etc.

Psoas is very tight which can pull my pelvis forward - its also weak! Have been working on transverse abdominals but can't really do anything to strengthen my mutlifidis as these exercise really tighten my back up. Am also working on the flexibility of the pelvic region and strengthening my glut muscles which support the hips and will help keep my pelvis in a neutral position and reduce anterior rotation

Whether what my osteopath is doing with my back helps or not only time will tell - someday its been better and some days very tight and sore in the facet joints. Spose a lot depends on whether his diagnosis is right i.e. is it a buldging disk for facet joint irritation that’s causing my main problems - I do get a bit of pins and needles in my shins and feet at times

Im hoping that by putting my biomechanics right will help take pressure off my back which will further aid its recover or stop it from getting worse

I do know of an orthopaedic neural specialist who claims he can force joints at of alignment and buldging disks back into place by using rare methods that hes developed over the past 30 years (he's in his 70's now) I've been to him twice and my problems go away for a 4-5 days and then I will feel something click out of place and symptoms come back. Once I get things functioning correctly again then I'll give him another try as I know a few people who have been sorted after one session!
My biggest tip for anyone is find someone that you trust and if they ever tell you not to get a 2nd opinion then stop seeing them - this is why my problems came about as was being treated by the symptoms for 6 months before it was obvious my problems were coming from my back. I just had a painful ankle and tight IT band after intense training and turns out it was all due to neural irritation in my back

 

[Kiaki]

You're most welcome.

I recently did a course with Tanya Bell, physio based in SA which really clarified the patterns of imbalance we can get in the body.
Have a look at the length of your piriformis,quadratus lumborum and Tensor fascia lata (you mentioned a tight IT band earlier and this can often add to anterior pelvic tilt), as all of these can alter lumbo-pelvic stability and position.
I'm intrigued as to how your Psoas is tight yet weak. If you can get someone to do a Thomas test on you and take out the action of TFL then you may find a different story. (you can check if piriformis is tight by flexing forwards within pain limits,with your hips in neutral:feet pointing forwards. Now externally rotate your legs and try again. If your range increases piriformis may be a problem)

In relation to multifidis exercises, it shouldn't be making your back worse. I wonder if you tried the exercises in a low-loading position like four point kneeling whether it might help? Doing it in front of a mirror can also be useful as it allows you to monitor whether you're using some of the big muscles ie. erector spinae/lats instead.

I'm finding with my chronic backs that piriformis and QL are the main culprits in radiation pain but everyone is different. The sciatic nerve runs under piriformis so that may also be bringing on your shin/feet pain. And QL can cause problems spinally if tight by over-extending and laterally flexing the vertebral bodies.

It's quite frustrating discussing your symptoms via e-mail when the work that I do is so hands-on!

Despite training and working for years in 'orthodox' medicine, I am a great believer in practitioner with years of experience and doing it their way. I believe that the best way to learn is by doing so your neural specialist guy sounds like it might be worth trying again.

Don't mean to throw too much info at you but it's also vital to look at how you spend your day and what postures you adopt when you're tired/on the phone/in the car etc. These will have the most impact on your rehab and recovery rate. Try the red dot method, (sticking red dots on your b/room mirror,your phone,your steering wheel etc and every time you see one engage your trans abs and pelvic floor for a ten second hold while you breathe diaphramatically)

Regardless of the diagnosis, disc prolapse/facet joint irritation etc. if you address the biomechanics, while you support the body as it heals itself(which it will), things will get better.

Rach

 

[Matt Kern]

thanks for the info

i ended up going into A & E today as after i went on the exercise bike the other day my legs felt weak after, i felt shakey ahd moderate pins and needles in both legs and my genitals were slightly numb for about 2 mins. I have also start to eperience a bit of stinging in my buttocks when sitting down for long periods and this also goes v close to my rectum and sometimes touches my testicals (i can't believe i've just disclosed that!!!) Anyway i read it could be a symptom of caudal equina so i got it checked out. All my reflexes are ok and no weakness in leg muscles and rectum strength ok BUT i do have a few symptoms that are slightly worrying ie minor bi lateral pins and needles,andoccasional feeling of weakness in legs and shakeyness. They suggested i get another MRI done but wouldn't do one on the NHS there and then as it wasn't life threatening - i kept trying to convice them but he said you would have to wait a month on the NHS. Im prob going to get one private in the nextfew days. They did get me an appointment with a orthopeadic doctor who deals with spine problems next week (first thing i've had on the NHS ever!!)as these symptoms have come on over the past few weeks he thought i should stop having any manipulationaand any see phyios to work in core stability and muscle balance until we know exactly whats going on via an MRI. My first scan showedlsight degeneration of L5/SI and thinks manipulation via the osteopath i've been seeing may of progressed this hence my new symptoms. Im going to use my brain and take this advise for once i think!

hopefully the MRI won't showup any further progressions

just to add form a biomechanical point of view im going to see mark buckingham (UK:A and british lions phyio) in two weeks. Hes going to go throuhheverything and in my opinion hes the best i've ever seen - he has a 6 week waiting list and is a 2 hour drive from where i live now otherwise he would of been handling this "full time"

will keep you posted next week