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low back pain

Posted By: KP
Date: Thursday, 6 December 2007, at 12:47 p.m.

Some reports say that low back pain will affect upwards of 60-80% of the population at some time or another. That seems conservative to me, but that may be because I am a chiropractor and see low back pain patients! Most occurrences improve within weeks if not days. However, about 5-10% of us will develop more chronic problems. Back pain is the:

*second leading reason for doctor's office visits in the U.S.,
*third most common reason for surgical procedures
*fifth most common reason for hospital admissions.
*most frequent cause of disability for people younger than 45 years of age
*most common painful condition reported by patients after headache.

The numbers tell us that it can be a difficult thing to manage // and that there may be a number of causations.
Below are some thoughts relating to one causative factor: Facet Syndrome.

Facet Syndrome or lumbar zygapophysial joint pain is one of the common causes of mechanical low back pain. Spinal vertebrae articulate anteriorly through intervertebral discs and posteriorly by paired joints. The posterior, thumbnail sized joints are called facets. In medical literature there are called zygapophyseal joints. Facets have a joint space, cartilage and a capsule. There are nerves (branches of the dorsal primary ramus) that innervate the facet joints. The joints play a major role is handling stress, movement and weight bearing in the low back. They help discs in resisting compression and do most of the weight bearing in rotation. They are also prone to wear and tear, just like other joints. The wearing may be due to past trauma (football, car accidents, bike crashes) or a congenital predisposition, or both. Additionally, if the disc themselves are dessicated or thinning, the facets will be exposed increased stress, be more prone to painful inflammation and the cycle of osteoarthritis can be progressive // not typical in the younger set unless there is a history of trauma.

What to do? You manage the condition. The joints are well innervated with pain and proprioceptive fibers. When irritated, muscular spasm can be mild or extreme. Prevention -- to help lessen episode severity and duration you can strengthen musculature of the core and low back which will aid weight bearing in the disc and facets. Patients with a strong core seem to manage low back pain better than others. In acute cases you can use ice and heat during the flare-up; maybe over the counter NAISDs. Traction can be very benefical if the facet joints are involved. Some patients benefit from electirc stim, ultrasound, deep tissue massage, ART and/or chiropractic manipulations of the zygapophyseal joints. Each case seems to respond a little differently. That may be because we show up in different stages of duress or the expertise of the provider we choose varies. Whatever the case, there doesn't seem to be "one right way" to deal with facet syndrome. If the condition is arthritic and worsens over decades it can be very difficult to manage (through whatever methods you choose). In more chronic cases, invasive treatment may become an option. Facet syndrome can be invloved with or separate from disc lesions, ligament damage, acute trauma, etc.

coach KP

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