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Facet Joint Strain, Syndrome and Therapy

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by: Peter Fuller (June 2013)

Neuromuscular therapy and Bowen therapy an appropriate measure for dealing with Facet Joint strain/syndrome and pain.

What is it?

The trouble with facet disease – and all other types of osteoarthritis – is that it cannot be cured or reversed. This means that if conservative treatments fail to alleviate the patient’s pain, spine surgery may be recommended to provide lasting relief.


Facet Joint Staring occurs when the small joints between the vertebrae, the facet joints, are overloaded or overstretched as a result of poor posture or an injury caused by the sudden movement of the joint.  The facet joints become inflamed and the muscles on either side of the spine go into spasm causing the back to become stiff and painful.  In severe cases the nerves can become irritated which may cause pain around the neck, spine, lumbar and side of the chest.

Erector Spinae Group_muscles_width600

Review of anatomy

Facet joints are small joints behind the discs which help to support the spine and allow it to move. There are 2 facet joints at each horizontal level; one on the right and one on the left of the spine. Facet joint surfaces are lined by cartilage. The facet joint itself is wrapped by a thick fibrous capsule that holds the joint in the proper alignment and gives it strength. Each facet joint receives 2 small nerve branches from the spinal nerves, which send sensory information from the facet joint to the spinal cord and then to the brain. If the facet joint is arthritic or otherwise irritated, the nerves send the information to the brain, which translates the information as “pain”.

Facet joints are susceptible to trauma and wear-and-tear changes. Trauma to facet joints such as Whiplash injuries, sleeping with a twisted neck, a sudden jerk of the neck, twisting while lifting overhead, or unguarded rotational motion of the spine, may lead to joint capsular tears, irritation of the joint surface, or distortion of the joint alignment. Daily wear-and-tear changes of facet joints can be caused by cartilage loss or spinal disc degeneration. In this case, the height between the vertebrae is diminished as the disc collapses, which results in abnormal loading forces on the facet joint at that level.

Facet syndrome in the upper neck region may present as headache at the base of the skull, aching behind the eyes, ringing in the ears, and upper neck pain and tenderness. Extension and rotation of the neck usually aggravates the symptoms. Facet syndrome in the lower neck region may manifest itself as pain and tenderness in the neck, shoulder and upper back, loss of cervical spinal curve, and is usually aggravated by neck extension and rotation.


Thoracic (middle back) facet syndrome may cause mid-back pain with muscle spasm, and loss of the normal thoracic spinal curve or occasionally pain encircling the rib cage. The pain is usually aggravated by spinal extension and rotation.


Lumbar (lower back) facet syndrome usually leads to achy/sharp/throbbing pain in low back, buttocks, hips and occasionally hamstrings, associated with muscle spasm of the back muscles on the same side. The pain is usually aggravated by pressing over the facet joints or simultaneous extension and rotation of the lumbar spine. This pain must be differentiated from sacroiliac pain, which can be in a similar distribution.

Neuromuscular therapy and Bowen therapy (Manual Therapy)

Bowen therapy appropriately applied to the spine may release the Erector Spinae (Para spinal Group) taking the pressure off of the nerves thereby allowing the muscles to relax in their normal resting position.  Neuromuscular therapy may be specifically applied to persistent restricted areas to illicit release of the tonic, toxic, tight musculature and surrounding soft tissue (ligaments, tendons, etc.).  Neuromuscular tools may often be employed where fingers are unable to fit and/or reach.

Goal of Therapy

Release the impacted muscles and soft tissue, dissipate the pressure clamping down on the nerves; alleviate the tight muscles, ligaments, tendons, and other soft tissue.  This is often achieved through the use of: Mayo facial release therapy, With Fiber manipulation, Cross Fiber manipulation, Direct Compression, Grasp, Hold, Uncoil, Money Sign, Bowen Therapy Principle (BTP Principle) and other various manual therapy methods.

Further Therapy

Treatment for this condition is normally first attempted conservatively with a combination of:

  • Pain medication, anti-inflammatory non-steroidal drugs, and muscle relaxants
  • Physical therapy
  • Stretching
  • Low-impact exercises
  • The application of heat
  • Massage

Additional Intervention Approaches / Strategies

Physiotherapy –   If exercise alone does not improve symptoms then physiotherapy treatment may be required.  A physiotherapist can use specific treatments including, ultrasound, deep friction, massage, interferential, acupuncture or taping to help relieve pain and aid recovery.

Therapy of facet syndrome

typically includes conservative measures such as local heat, traction, anti-inflammatory medications (NSAIDS), muscle trigger point injections, physical therapy, manipulation, and interventional treatment such as facet joint blocks, dorsal median branch nerve blocks or denervation and Prolotherapy. Unfortunately, there has not been a curative treatment for arthritis itself. After failing conventional measures, facet joint injection is usually performed. If the injection produces significant but short term pain relief, denervation of the facet joint can be performed to eliminate the painful sensation from the joints and thus provide long term pain reduction (in 80% of cases).

Treatment of Arthritis

The trouble with facet disease – and all other types of osteoarthritis – is that it cannot be cured or reversed. This means that if conservative treatments fail to alleviate the patient’s pain, spine surgery may be recommended to provide lasting relief.

Magazine Articles

Bowen Technique Massage Article CondensedMASSAGE Magazine, by Vicki Mechner

Issue # 106 (Nov/Dec 2003) pp. 102-107

Newspaper Articles

49er Great Roger Craig Still on the Run
Mercury News, by Mark Emmons
Posted: 10/03/2008

No Pain No Gain Kid
Sports Illustrated, by Jill Lieber
November 28, 1988

NFL Notebook Craig Sets the Pace for Running Backs
New York Times, by Thomas George
October 11, 1988