Back Pain When Standing.

It may be lumbar facet syndrome.


Do you have back pain that is worse with standing, leaning backwards or twisting, and feels better with sitting or bending forward? If so, you may have a condition called lumbar facet syndrome.


What is Lumbar Facet Syndrome?


Estimated to account for up to 40% of all low back pain cases, lumbar facet syndrome is a condition that affects specific joints in the spine. Called lumbar facet joints (also called lumbar zygapophyseal joints), these joints are responsible for allowing and preventing directions of motion in the low back. Their shape and orientation in the lumbar spine (spine in your low back) primarily allows for bending forward and backward, and limiting twisting.


When these joints become painful, damaged, and inflamed, it is termed lumbar facet syndrome. Disorders, including osteoarthritis, tears of the ligaments surrounding the facet joints, cysts within the facet joint tissue, degeneration of the cartilage inside of the facet joint, and soft tissue injury of the multifidus muscles (muscles in the low back), can all contribute to the pain and progression of lumbar facet syndrome.


What causes Lumbar Facet Syndrome?


It is believed that standing, leaning backwards, and twisting cause an increase in back pain because these motions increase pressure and compression of the lumbar facet joints. While sitting and bending relieve pressure on these joints, accounting for the decrease in pain.


Individuals over the age of 40, who experience repetitive backward bending of the low back, repetitive twisting of the low back, are overweight, and/or have weak abdominal core musculature, appear to be at greatest risk of developing this condition. An injury where the low back is forcefully hyper-extended can also cause damage to the facet joints leading to facet syndrome. In this situation, fracture should be ruled out first.


How is Lumbar Facet Syndrome diagnosed?


Imaging, such as x-rays, CT scans, MRI, and PET scans can be helpful in ruling out many different low back conditions. But, the diagnosis of facet syndrome is usually made based on consultation, medical history, and a thorough physical examination.


For some time, the relief of pain by performing an anesthetic injection into the facet joint was considered to be the gold standard for diagnosing facet syndrome. In this case, the procedure is used to both diagnose and treat the condition at the same time. Unfortunately, this approach is not always a reliable way diagnose the condition or an effective way to treat it. As such, conservative treatments should be tried before moving on to more invasive procedures.


What is the best way to treat Lumbar Facet Syndrome?


Exercises like yoga, Pilates, and core strengthening, as well as using anti-inflammatory supplements (such as those I wrote about in The 7 Best Natural Anti-Inflammatory Supplements) may all be ways to reduce pain and improve the condition on your own. If these don’t help or the condition is worsening, seeking help from a chiropractor may be the next step.


Chiropractic treatments should focus on decreasing stress and pressure on the facet joints by restoring normal motion and alignment of the lumbar and thoracic spine, as well as the sacrum, pelvis, and hip joints. In addition, imbalances, weakness, and tension in the musculature of the hips, low back & core musculature, and latissimus dorsi, must all be evaluated and treated accordingly. Education on lifestyle and activity modification, proper ergonomics, and weight loss should all be a part of the discussion with this holistic approach.


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Wishing you good health.

Dr. Hagman


DR. JASON HAGMAN

For questions or to schedule an appointment with Dr. Hagman, please call: (973) 564-7676

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