What is a Facet Joint Sprain?
Facet joint injuries, dysfunctions, or sprains are an injury to part of your vertebra.
The word “sprain” means that one of the ligaments has a tear. The tear could be small, moderate, or full-thickness.
Ligaments connect bones to other bones (they do not connect to muscles). Their job is to prevent a joint from going so far that it, or other parts of your body around it, will get damaged.
Facet joints are very close to the nerves coming out of your spinal cord between your vertebrae – these are called “nerve roots.” Nerve roots are sensitive, so if your facet joint is inflamed ti can irritate the nerve roots, causing increased pain sensations even though the nerve root itself may not actually be damaged. It’s just the proximity of the nerve root to the inflamed facet joint sprain that causes the increased pain.
That pain can radiate out to other parts of your body. For example, a facet joint sprain with nerve root irritation in your neck (a “cervical facet joint sprain”) may radiate pain down your arms and into your hands, or into your shoulder or shoulder blade. A facet joint sprain in your lower back may radiate pain down your leg and into your foot.
Acute phase is the first few hours and days after your injury. If you have serious neck pain of any kind, seek medical help immediately. If you have mild neck pain, you may just need to rest for a while. If you’re not sure, call a medical practitioner for advice.
Don’t apply heat in the acute phase, this will likely further irritate the inflamed joint and lead to more pain.
Remedial massage and other therapies are generally a bad idea during the acute phase of any injury. You can go see a massage therapist or other type of physical therapist (see the last section below for options), but they will probably work around but not on the site of injury.
What to do during acute phase
Try applying some ice for up to ten minutes at a time. Use the 10-10-10 protocol: ten minutes on, ten minutes off, ten minutes on again.
This should dampen the pain signalling down to a level that is appropriate for the injury. If, after icing, there is still sharp pain, or pain that travels down your arms or legs, call a doctor for advice. If the remaining pain is only where the injury is, rest it. Anti-inflammatory medication such as ibuprofen or paracetamol may help you – always follow the instructions on the packet or leaflet that comes with the medication.
If ibuprofen or paracetamol don’t make any difference to the level of pain, call a doctor for advice. If they do help, rest. And I do mean rest. “Rest” does not mean continue to sit at your desk and work. It doesn’t mean do your house chores or exercises. It means sit or lie down and relax.
Your body wants to heal, give it the opportunity to do what it needs to do.
Remedial massage might be good for you during the sub-acute phase. See the next section for more details.
After a few days, the main burst of inflammation will hopefully have dropped off and you should be able to move around without too much discomfort, although there will probably still be some pain on certain movements.
Don’t. Get. Cocky.
The facet joint sprain is still sensitive to re-injury. If you push yourself, you may make yourself worse than you were to start with!
Take it easy. Now is the time to find a good practitioner to assess your injury and find out an appropriate pathway for therapy and recovery.
After a few weeks, if your pain level has continued to decrease and you are feeling like you are getting better, it’s time to go get some therapy to support, encourage, and accelerate the healing process.
During the recovery phase, your body is rebuilding and re-organising itself back to where it was before the injury. This is when you should bring restorative movement back into the process so that you can avoid stiffness and immobility.
Getting treatment and advice for this process is the best thing you can do.
Remedial Massage for Facet Joint Sprains
Acute Phase Treatment
During acute phase, remedial massage will just aim to help the muscles around the injured joint to relax so that they aren’t pulling on the joint and increasing your pain. I would probably do a shorter appointment like 30 or 45 minutes since this is unlikely to take long.
Sub-Acute Phase Treatment
During sub-acute phase, we can carefully try some gentle stretching for the affected joint. When doing this, if your joint starts to feel worse, we will stop and just work on the muscles. If it feels better, we’ll work only within your tolerance to put some space into the facet joints with the intention of improving comfortable movement.
The less irritation there is in the facet joint, the less pain you will experience via the nerve root.
Therefore, the more easy movement there is in the facet joint, the less pain you will have. This approach aims to speed up the your healing time and increase comfort.
Recovery Phase Treatment
Remedial massage therapy is an excellent option during the recovery phase.
Joint work is much easier since your will be able to tolerate it without much discomfort. We aim to restore normal range of motion and function to your joints, and support the muscles that have probably been working harder than normal to protect the injured joint and irritated nerve root.
Firm but gentle stretches and mobilisations for the joint, and lots of massage for the muscles, are the order of the day. During this phase, between three and six treatments should hopefully resolve your facet joint injury, unless there is lasting damage to the joint.
If, after six treatments, you are still experiencing pain or discomfort, I would likely refer you on to another practitioner who has the option of performing scans like ultrasounds or x-rays to see exactly what’s going on inside that facet joint.
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Other Treatment Options
Your options for other people to talk to include:
- Physiotherapist: will assess you, may perform scans like ultrasound, may refer you to a specialist, and can advise you on painkiller medication. They will usually prescribe appropriate stretches and exercises. Some will do soft tissue therapy (ie, massage or assisted stretches) but physio treatment is mainly based on giving you stretches and exercises to help you recover. DO. YOUR. EXERCISES. Appointments are usually 15–30 minutes.
- Chiropractor: will assess you, may refer you for scans like x-rays, may refer you to another specialist, and can advise you on painkiller medication. They may manipulate or adjust you or use an activator (a tool that makes a clicking noise) to shift your vertebrae with the intention to improve nerve function. They may also give you exercises to do at home between treatments. DO. YOUR. EXERCISES. Appointments are usually 15 minutes.
- Osteopath: will assess you, may refer you for scans or to another specialist, and may manipulate, adjust, or perform soft tissue therapy such as myofascial release. Osteos tend to be more holistic and might ask you about your habits and patterns, advising you on how to make changes. They may also give you exercises to do at home between treatments. DO. YOUR. EXERCISES. Appointments are usually 20–45 minutes.
- Myotherapist: Myos are an Australian type of soft tissue therapist. They will assess you, may perform limited amounts of manipulation, joint mobilisation, or adjustment, but not like a chiro or osteo. They often use dry needling to release muscles or affect joints. They lean heavily on soft tissue therapy like massage and myofascial release. They may also give you exercises to do at home between treatments. DO. YOUR. EXERCISES. Appointments are usually 45–60 minutes.
- Acupuncturist: will assess you and treat you according to the traditional Chinese, Korean, or Japanese styles of medicine. They may apply needles to meridian points with the aim of stimulating the healing functions of your body to accelerate the healing process. They may also prescribe herbs, habit changes, or exercises to speed the process along. DO. YOUR. EXERCISES. Appointments are usually 30–45 minutes.
- General Practice Doctor: will assess you and can accurately prescribe pain medication, and may refer you for highly accurate imaging scans like ultrasound, x-ray, CT, or fMRI. They do not generally to soft tissue therapy and rarely prescribe exercises. Appointments are usually 15–20 minutes. If you wish to get a highly-accurate picture of what is happening with your injury, you may wish to go through this process before heading to see another of the abovementioned practitioners.
That’s it! You should now have a good idea of what to do about your possible facet joint sprain.
I wish you a speedy recovery!