Facet joint malfunction

Abstract

The extent to which the facet joints are involved in the production of low back pain is one of the most widely debated topics in this branch of medicine. Some deny that facet joint pathology is ever a cause of backache whilst others cite these lesions in the majority of cases. The interdependence of apophyseal joints, discs and ligaments has been described and it is usually impossible to identify the exact site contributing to the pain. It is usually safer to ascribe symptoms to mechanical derangements of a general nature rather than specifying a condition such as ‘locking’ of facet joints or ‘blocks’, the existence of which can only remain speculative. Jayson (1978) casts the same doubt upon subluxations of the apophyseal joints, pointing out that neither microscopic nor macroscopic evidence of such changes has been demonstrated in these joints. On the other hand Adams (1971) describes momentary subluxation, with consequent ligamentous strain in an inter-vertebral joint that is unstable on account of disc degeneration or osteo-arthritis, as a cause of acute lumbago (which he denotes as a syndrome of sudden, agonizing pain in the lumbar region, usually occurringon stooping, lifting, turning or coughing). Reilly et al., writing in Helfet and Lee (1978), suggest that ‘chiropractic manipulations work by reducing minor sublux-ations of a lax posterior joint. This laxity would also explain the tendency to recurrent episodes of low back pain.’