Facet joint osteoarthritis
Osteoarthritis (degenerative
arthritis) can cause breakdown of cartilage between
the facet joints. When the joints move, the lack of
the cartilage causes pain as well as loss of motion
and stiffness.
The facet joints are located in the back portion (posterior)
of the spine. The joints combine with the disc space
to create a three-joint complex at each vertebral level.
The facet joint consists of two opposing bony surfaces
with cartilage between them and a capsule around it
that produces fluid. The combination of the cartilage
and the fluid allows the joint to move with little
friction. However, facet joint arthritis causes the
cartilage to breakdown and the joint movement is associated
with more friction. The patient loses motion and as
they get stiffer they have more back pain.
Low back pain from osteoarthritis
Typically, the low back pain is most pronounced first thing in the morning.
Throughout the day, normal movement causes fluid to build up in the joint
and it becomes better lubricated, which decreases the pain. Later in the
day the pain typically becomes worse again as more stress is applied across
the joint.
Conservative treatments for osteoarthritis
Conservative treatments that concentrate on maintaining motion in the back
are most effective for relieving the pain.
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Stretching exercises for the hamstring muscles,
hip joints, and the back can usually serve to prevent
the pain from getting worse.
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For more severe pain, chiropractic manipulations
can help relieve pain.
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Water therapy can be also be helpful since the
joints are unweighted in the water and do not generate
as much pain when being moved.
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Acetaminophen is an effective and relatively safe
non-prescription medication to help alleviate the
pain, and some patients find NSAID's (including
Cox-2 inhibitors) to be helpful.
Surgery for osteoarthritis
The only effective surgical treatment option for osteoarthritis is a fusion
to stop the motion at the painful joint, but this surgery is generally not
recommended since multiple vertebral levels tend to be affected by osteoarthritis
and multilevel fusions are generally not advisable.
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