Are facet joint exercises a logical solution for facet joint syndrome? Why would mobilization of the painful tissue be prescribed when the symptomatic source is virtually always movement of this same affected joint? Are doctors just crazy?
Facet joint pain is often treated conservatively with physical therapy. Although exercising the back often produces escalated pain, there can actually be some benefit for particular patients and conditions towards eventual pain relief. However, there is even more of a chance of suffering aggravated symptoms long-term from many structural pathologies in the spine when the back is exercised. So, is exercise logical as a facet joint pain treatment or not?
This discussion focuses on the use of general exercise, and physical therapy in particular, for the treatment of painful facet joint syndrome. If you are wondering why you have worse pain from facet syndrome when exercising, this article will tell you everything you need to know.
Exercising Painful Facet Joints
Many patients seek help for back or neck pain that is experienced when moving certain areas of their spine. When facet joint syndrome is the diagnosis, this is logical, since the vast majority of patients suffer pain when the affected joint is mobilized and do not suffer pain when the joint is rested.
Exercise generally utilizes the back muscles which also move the vertebral column, so most physical activities will produce pain to one degree or another. However, when specific exercises actually target that joint and move it continuously, the pain can become much worse. This is what happens to many patients who undergo physical therapy for facet joint pain diagnoses. Some actually quit treatment citing that they only had minor pain before starting PT, but got much worse afterwards and did not want to have to deal with such agony. In essence, they went to the doctor looking for relief, not to make their pain WORSE.
Efficacy of Exercise Therapy
Physical therapists do not want to hurt patients. However, there is evidence that many cases of bone spur-related facet joint pain will resolve with exercise, including targeted PT. In these cases, the reason why physical therapy works is simple, but often very painful for some time… When an osteophyte interferes with normal facet joint movement, pain is elicited when the joint is mobilized. Continual mobilization of the joint can wear away the osteophyte in some patients, relieving pain and restoring normal function. This is the logic behind most facet joint pain PT recommendations.
However, it is important to know that in more cases than not, the osteophytes will not resolve and might grow larger with the constant aggravation of mobilization, making the condition worse structurally and symptomatically. The results of PT are unpredictable to a large extent, although some conditions are certainly more indicated than others based on imaging evidence gathered during diagnostic evaluation.
PT Analysis of Facet Joint Exercises
We like conservative care and constructive care. PT is generally a good option to try for many types of pain. However, due to the intense flare-ups that can occur, as well as the possibility for structural aggravation of the diagnosis, we fall short of recommending PT or any type of exercise therapy that worsens pain for treating facet syndrome.
We see many patients who enjoy very good results from PT in a short timeline, most often indicating misdiagnosis of the underlying mechanism of pain in the first place. Most of these patients are probably suffering from ischemia syndromes and the exercise brings improved circulation, helping to relieve the symptoms temporarily. However, most of these cases will suffer a relapse of pain after exercise ceases or will develop new pain elsewhere which will not respond to the same form of exercise therapy. In profiles like these, PT might offer a temporary fix, but the only way to actually cure the pain forever is with appropriate knowledge therapy that will disable its mindbody source.
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