After Treatment Advice

Facet Joints

Facet joints are pairs of joints between each vertebra guiding the vertebra's movement. These joints are fluid-filled like your knee or ankle joints. Synovial Joints [from the latin 'like eggs', because the fluid inside looks like the albumin/white stuff in the egg]. They have ligaments to support them, capsules to keep the fluid in and muscles to move them. There are nerves coming out between each segment to supply the body with sensory and motor information and each nerve supplies different areas of the body.

These facet joints can be sprained and may swell, and the injured ligament or capsule then sends a message to the central nervous system, which recruits the muscle around the area to protect your injury; especially painful if they 'pinch a membrane'. If you have experienced the knee jerk reflex, then this is very similar, except that the reaction is full on all the time as the muscles constantly contract to protect the area from further injury pinching the membrane harder and you go into spasm.

Your Symptoms

The facet joint is now firmly held by the surrounding muscles.

It may pinch the sensitive capsule and this can give you a very sharp pain, especially when you move.

The joint is swollen which causes stiffness, especially after a period of rest.

The muscles are working all the time protecting the area, this causes them to tire and thus they ache.

So you have a sharp point pain close to the spine, and a background ache to the back and buttock region.

This can cause sciatica and, if the joint becomes very swollen, may cause nerve root irritation as the joint is adjacent to where the nerve exits [see above] and the joint swelling may press against the nerve.

Sciatica

This is when the large Sciatic nerve, that passes out of your pelvis into your leg, is pressed on by an enlarged muscle called the piriformis (which has grown bigger by the excess work demanded on it by protecting your injury.)This nerve pressure gives referred pain to the leg, varying from around the buttock area to all the way down to the ankle. The back pain may mostly clear up but the sciatica continues because the injury has not been completely resolved.

Disc injury

This is the protrusion of the disc’s liquid centre bulging out of its fibrous coat. Symptoms vary, depending on what the bulge presses against. If it presses against the spinal cord, you will get symptoms of pins and needles/numbness to both legs and probably bowel and bladder dysfunction — this is a surgical emergency. It can cause symptoms of nerve route irritation or just a generalised ache.

As the nerves exit the spine near the disc/facet joints any swelling of a disc or joint injury may press on it’s local nerve root and cause varying sensations, eg. pins and needles, pain and/or muscle weakness. These sensations will be felt in the areas that the particular nerve supplies, i.e. for the 5th lumbar nerve [L5] this would show up as pain/pins and needles/numbness and or muscle weakness to the outside aspect of the calf, round to the inside of the foot, the big and second toe and the sole of the foot. Just to confuse the matter you can have both nerve root irritation and sciatica at the same time.

Treatment Reactions

In the course of treatment, you may experience 'gapping' of the injured joint. This should release the pinching sensation, and improve the range of movement, but in doing so, it may slightly irritate the area and cause inflammation and some discomfort for 24-48 hours.

If there is extra swelling you should use an ice pack or frozen peas (wrapped in a tea-towel to stop frost-bite) for 20 minutes every 3 hours, which will help to reduce the swelling. Two days after treatment you should use the contrast bathing technique with the alternate use of hot and cold packs.

You will be slightly susceptible to re-injury and should refrain from repetitive chores such as ironing, washing up, making beds and hoovering/vacuuming. This may sound good, but you should also refrain from sitting too long in front of the television, thereby balancing activities between exercise and rest.

The healing time for a facet joint irritation is about 3 weeks;

rather like the time it takes for you to get over a twisted ankle and fully side step on it. You should be careful during that period so as not to re-injure the area. We ask you to come back after the healing time so as to re-assess your body in your normal state, possibly finding other problems that may be predisposing or maintaining your injury.

Healing time for disc injuries

These are much harder to assess as they have a bad blood supply. The best way to improve disc healing is to make sure they are under the least stress to minimise pressure, and thus their bulging, and so maximise their healing potential. Changing your lifestyle or job may be one option to facilitate this, often the pressures of work and home may make this a difficult decision. Who likes being told to change?

General Life Advice

Here at Lowbourne osteopaths we give advice to reduce the risk factors that have caused your injuries.These include personal lifestyle principles at home and at work and possible changes to the ways you conduct your daily life.

Looking after your body:

Weight

Weight is measured in pounds per square inch, or kilos per square metre. Caspar is an old imperialist so he uses pounds/square inch. If you put on 10lbs, squared gives you 100lbs and that is the amount of pressure you have increased through your joints. Thus if you lose 10lbs you reduce the pressure by 100lbs.

Exercise

We advise you do exercise that is appropriate for your condition and that you enjoy. One has ‘to get fit to do a sport’ and not to ‘do a sport to get fit’. If you have arthritic joints then we advise you take up swimming or 'aqua fit, as it is a non-weight bearing exercise and does not cause further damage to your joints.[see our sports and osteopathy section].

Stretching

We advise people to stretch more often during the day. Caspar likes the idea that you have a good stretch when you yawn, like animals do. If you can have a small stretch every 20 minutes this will prepare your body for most unforeseen or planned movements throughout the day.This is preferable to a single stretch in the morning.

When doing stretching people ask "How should we do it?"

Basically one wants to consider every joint in your body being taken through a full range of movement, i.e. if I was stretching my neck, I would flex it forward then extend backwards, rotate left and then right, then side-bend left and right. It is advisable for to do these movements before doing any other movements, like neck rolling. If you can try to stretch different parts of your body with each yawn, although in the car it isn’t as easy to do a full shoulder stretch and in the office you may get funny looks as you open your mouth wide and stretch with a good yawn. If they complain that you are being rude just point out to them that it’s a natural thing to do!

Circuits at work rest and and play:

If one has a selection of chores to do,eg. gardening or housework, then try and break them down into smaller chunks so as not to do anything for too long, as one does in the gym during circuit training. This would reduce the chances of you fatiguing the muscles by overworking them during repetitive tasks. Fatigued muscles cannot protect your joints effectively and you are more likely to strain yourself. So, mow the lawn for 10 minutes, do some edging for 10 minutes, hoe the flower bed for 10 minutes, deadhead the flowers for 10 minutes, dig for 10, collect their heads and compost and, then start again mowing etc. At the end you can sit down and have a gin and tonic and watch the flowers grow.

These simple ways of conducting your life can reduce the risk factors that may cause injuries.