Facet Syndrome and stenosis vs. Lumbar Disc Herniation
Facet Syndrome and stenosis vs. Lumbar Disc Herniation
NNMC Bethesda Chiropractic Clinic
Designed and created by Erika Warner, D.C.
Facet Syndrome/Stenosis
Painful Extension Posture Associated with Stenosis and Lumbar
Facet Syndrome
IVF & Canal Stenosis
When reacting to stress, the adult bone structure responds by creating more bone to stabilize the injured area.
decreased space for exiting nerve root
IVF Stenosis
Normal Anatomy
facet joint composed of superior articular process
inferior articular process
Disc Herniation
Painful Postures and Movements Associated with Lumbar Disc Herniation
Postures that create flexion and/or rotation of the lumbar spine
Normal Anatomy
Exiting Nerve Root
facet joint hypertrophy
Canal Stenosis
decreased canal space
Injured areas need more support. Ligaments thicken to help accomplish this.
Unfortunately creating more bone and ligament takes away space for nerves in the spinal canal, and decreases the space where the nerves exit through the intervertebral foramen.
ligamentum flavum hypertrophy
Facet Joint Cross Sections
Facetal Edema
Painful Facet Joint
Painful Lumbar Disc and Nerve Root
normal mild
In a normal, healthy joint the space within the joint is clear. The cartilage lining the joint is smooth and uninterrupted.
Joints likes these move freely and smoothly and are not painful. These joints have good nutrition.
fatty infiltration of the mutifidus muscle
In a joint with limited motion, thread-like adhesions are seen forming within the joint space. The cartilage lining the joint is rough and interrupted.
Joints likes these do not move correctly and are often painful. These joints have decreased nutrition
The multifidus
Inactivity is the biggest threat to the spine. Muscles that are not exercised routinely begin to form fatty deposits which severely limit the muscles ability to perform its function.
The mutifidus is an important stabilizer for the spine. Ones ability to activate this muscle quickly and evenly serves as protection for the back in stressful postures and
movements.
Facet Joints
Normal Disc Material
Cauda Equina Nerve Roots
Normal Spinal Canal Diameter
Degenerative Disc Disease
Degenerative disc disease is the precursor to disc herniation. When the spine does not move, the discs are unable to bring in water and nutrition. Lack of nutrition and hydration shrinks the disc and creates small tears in the disc. These tears become weak points through which disc
material may herniate when increased positional stress is placed on the disc.
Degenerative Disc Disease posterior disc herniation
Before
After
This disc herniation is located between the L4 and L5 vertebra and extends posteriorly. Because of its shape, it is called a protrusion.
Chiropractic treatment can help decrease the symptoms associated with disc herniations, and may decrease the size of the herniation over time.
Movement of the joint discourages the growth of adhesions. When a joint is immobile for a long period of time the formation of large adhesions are seen. These connections in the joint severely limit motion.
Severe
Adhesions form like vines over a closed garden gate. To open the gate you must break up the vines. Adhesions must be broken to restore motion to a joint. Breaking these adhesions will cause mild inflammation and soreness, but will restore motion and nutrition to the joint.
TEMPLATE DESIGN ? 2008
Pain patterns
Unlike disc injuries, which are most painful in the morning after the disc has rehydrated, IVF and canal stenosis tend to be more painful towards the end of the day as the disc becomes less hydrated and the space available for exiting nerves
decreases. Facet syndrome also becomes more painful toward the end of the day as tired joints
have had increased pressure on them throughout the day
Relief Postures and Movements
Those with lumbar disc derangements find extension to be less painful than flexion. Lumbar disc derangements may respond well to extension exercises.
The use of ice or heat may be advised by your doctor. Always use towels to avoid burns or frostbite. Never exceed 20 minutes for either
modality. Characteristically ice is used for new or inflammatory conditions, and heat for more chronic conditions. Those with diabetes or other conditions with impaired circulation or impaired perception of
feeling should avoid both ice and heat.
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