Hi guys, in today’s blog, we are going to discuss the difference between disc pain and facet joint pain. Discal and facet-related spinal pain are common problems that we see daily in the clinic, they can occur in the neck (cervical spine), mid back (thoracic spine), or lower back (lumbar spine).
In order to understand what creates the pain we need some basic knowledge of the anatomy of the structures involved. An intervertebral disc is a soft, cushion-like structure located in between each vertebra in the spine (except the top two neck vertebrae). It is a kidney-shaped structure that is composed of 2 parts:
1. The annulus fibrosus – is the outer part of the disc. It is made of concentric rings of tough fibrocartilaginous tissue called lamellae.
2. The nucleus pulposus – is located in the center of the disc and is a gel-like substance that acts to resist compression.
The disc acts as a major shock absorber for the spine, absorbing stresses created by static (sitting) and dynamic (bending/lifting) movements.
A Facet joint, also known as a zygapophyseal joint or Z joint, is a joint made between vertebrae. These joints allow mobility and stability of the spine. For each vertebra, there are 4 facet joints, 2 on the left at the top and bottom and 2 on the right at the top and bottom to allow articulation with the vertebrae above and below.
At the end range of spinal extension (leaning back) the facet joints close and compress together, whereas when we move into flexion (bending forward) the facet joints open. We’ll touch more on how this relates to pain in just a moment.
So what creates the problem which leads to discal pain?
A disc tear, herniation, or space-occupying bulge will often be accompanied by nerve root irritation. In this injury, the bulge from the disc compresses the nerve root, from the spinal cord, and sends pain into the hip, leg, ankle, or foot along a specific nerve root distribution. It is this distribution that helps clinicians determine at which level of the spine the disc bulge has occurred.
It is rare to have a facet joint syndrome refers to pain that can be tracked to a specific nerve root distribution, although referred pain can occur from facet-related problems, they are in a more generalized pain pattern.
So how do these injuries happen?
Facet joint injuries tend to occur quite acutely. Usually, there has been an underlying degree of stiffness built up in the joint (generally posture related) and then a quick sudden movement involving flexion and rotation forces the two joint surfaces apart sprains the joint capsule and small ligaments that surround the joint. This creates inflammation, pain, and the presence of facet joint dysfunction.
Discal injuries can occur acutely (lift and twist) or progressively (sustained postures) over time. Given the anatomy of the disc, the nucleus pulposus moves in relation to the pressure or compression in the spine. As humans, we spend a lot of time in a flexed or bent position (sitting at work, driving, etc). In a seated position, we place a lot of pressure through the front of the disc which squeezes the nucleus pulposus toward the back of the spine where the rings of lamellae bunch up and become thinner. Constant pressure over time can cause the nucleus pulposus to break through some of these rings which creates a disc bulge. The more rings it breaks through the larger the bulge will be.
The signs and symptoms of disc and facet joint injuries overlap quite a bit and can include; sharp pain in the affected area, inflammation, muscle stiffness around the joints, and loss of range of motion. Aside from the presence of neurological symptoms, there is one main movement difference that separates these two conditions: that is disc injuries tend to be very sensitive to forward flexion and facet joint injuries tend to be very sensitive to extension.
Can these conditions be treated?
By all means yes! Whilst medical imaging for back pain is becoming increasingly popular it is always worth investing in a conservative line of treatment prior to engaging in more invasive procedures.
The key to treatment is accurate diagnosis. Because discs tend to dislike flexion we treat them into extension and because facet joints don’t like extension we treat them into flexion. As you can guess if one way makes it better, the opposite way will generally make it worse and so without an accurate diagnosis, it may be being treated in the wrong direction.
It’s important to note that our spine is a very strong and robust structure designed for movement and very rarely does it break. With this in mind it’s important when we have back pain to keep on moving, just make sure we are doing it in the right direction. These conditions can be very delicate and without accurate diagnosis and treatment they can either get worse or relapse due to segmental instability around the spine.
Both conditions involve similar manual therapy treatments, with the aim being to reduce inflammation and pain, release muscle tension and mobilize stiff joints to restore movement to the spine. This is followed by a specific, directional, movement-based exercise program to maintain ROM and is completed with a core strengthening program to minimize the risk of recurrence.
What can I do to prevent spinal issues from arising in the first place?
1. Ensure you have a good Ergonomic set-up at your desk, bike, car seat, etc. This acts to prevent poor posture that promotes spinal stiffness and overloading in one position. If static movement can’t be avoided, getting up from the desk and stretching every hour is imperative.
2. Movement and stretching before and after exercise to keep muscle tension low as possible. The real problem with most musculoskeletal problems is the lack of movement which promotes stiffness and predisposes us to injury. So move regularly and engage in regular exercise. It doesn’t even need to be anything specific, just make sure you keep on moving.
3. Core strength and stability – a strong spine is a healthy spine, so engage in regular strength exercises for the core muscles to ensure they provide your spine with the support it needs.
So that’s a brief overview of how disc and facet joint dysfunctions can occur and the main differences between the two. If you have questions or comments, feel free to e-mail us at [email protected] and we will happily answer them for you.
If you think you may suffering from a disc or facet joint-related injury and want an accurate diagnosis today, then call us on (08) 9486 86653 and we will arrange an appointment for you.