By: Dr. Brian P. Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN
Back pain is an epidemic that on a year to year basis medical practitioners continue to treat. In the United States of America alone, there is an expected 31 million people with lower back pain at any given time. As many as fifty percent of Americans report some type of back pain every year, while some of these problems are minor, statistics show that roughly one third of all Americans aged 18 or older have had back problems within the past five years causing a trip to the physician's office. The National Institutes of Health (NIH) reports that seventy to eighty-five percent of all people have back pain at some point in their life. The financial strain of the problem is also quite profound with over fifty billion dollars spent per year in the pursuit of clearing up cases of back pain. Many experts place the likelihood of any person to experience some type of back problem throughout their lifetime at about eighty percent that is four out of every five people.
So then what exactly causes back pain? Even with today's technology, the exact cause of low back pain many times may not be determined. In most cases, back pain may be a symptom of many different causes ranging from; overuse, trauma, degeneration of the spine including arthritis, infection, tumor, obesity, poor muscle tone, sprain or strain, or protruding or herniated disk.
One of the many causes of lower back and neck pain can be due to the joints between each vertebra in the spine which are known as facet joints. There are twenty four vertebrae which form the human spine, and there are two facet joints between the vertebrae of each spinal segment along the spinal column. A facet joint has two bony surfaces with cartilage between them and a capsule of ligaments surrounding it. When these facet joints become inflamed or irritated a condition known as facet arthropathy can develop. Facet arthropathy is a degenerative condition affecting the facet joints in the spine therefore arthritic pain can develop.
Some of the causes of arthritic facet arthropathy may include: excessive wear and tear of the joints which causes the space between the vertebra to decrease and the facet joints to rub together, a previous back injury or fracture which has damaged the facet joint or the cartilage in the facet joint, and damaged ligaments or discs which alter the stability of the spine placing more weight on the back of the spine which includes the facet joints. Excessive stress on the back of the spine may cause the cartilage to degenerate stimulating arthritic changes and even the development of bone spurs.
The main cause of facet arthropathy is spinal degeneration which usually occurs later on in life. Pain is typically the primary sign of facet arthropathy. The pain may be exacerbated by activities requiring twisting or bending backwards, but typically it does not radiate down the legs or buttocks unless a bone spur has developed and is putting pressure on a nerve.
Facet arthropathy is usually diagnosed by a medical practioner with the use of X-rays, CAT scans, and MRI's. More specific diagnostic procedures include performing a guided injection using a fluoroscope where medicine and dye are injected into the facet joint. The dye allows the physician to view the placement of the needle and injection. If the facet joint is injected and pain relief is the end result, it confirms the diagnosis of facet arthropathy. This is better known as a diagnostic block and is usually performed by a pain management physician.
Following the diagnosis of facet arthropathy, one of the more conservative treatment approaches by your medical practitioner may include a referral to Physical Therapy. Physical Therapists are skilled medical practitioners trained in biomechanics and human anatomy. At your initial consultation the Physical Therapist will perform a mechanical examination of your lower back attempting to determine the exact cause of the irritant to the facet joints or your lower back pain. From there he or she can develop a rehabilitation program designed around prevention and wellness including activity modification to assist the pain management physician in resolving your condition. It has been my personal clinical experience over the last ten years seeing the best clinical outcomes for the treatment of many forms of lower back pain using the combination of pain management and physical therapy.
Professional Rehabilitation Services is a Physical Therapist owned Private Outpatient Physical Therapy Practice specializing in pain, orthopedics, balance and sports injuries with offices in Myrtle Beach and Pawleys Island, SC. For more information on this topic or to schedule a consultation please contact Brian Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, at our Pawleys Island office at (843) 235-0200, Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN at our Myrtle Beach office at (843) 831-0163 or Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN at our Myrtle Beach office at (843) 839-1300, or visit us at: www.prs.rehabservices.com.