How Can Pain Come from Joints in Your Spine?

When you think of joints in your body, the “usual suspects” come immediately to mind: knees, ankles, wrists, knuckles in fingers and toes, shoulders and elbows. Even before you can remember, back when you were learning to talk, your parents may have played a little game with you. Where’s your nose? Where’s your ear? Where’s your shoulder? Where’s your elbow? They would praise you when you pointed to the right body part.

Joints are where the ends of bones meet, and they are complex because they depend on the interaction of muscles, ligaments, and tendons that help them bend and twist. To protect the tips of the bones from the friction of rubbing against each other, most joints are lined with a material called cartilage. Cartilage is a firm but flexible tissue, but it has no blood vessels or nerves.

The joints you probably don’t know you have

You may not realize it, but you have some very important joints you probably never heard of. As a little kid, you could not have pointed to them because they are located between each of the vertebrae (backbones) that make up your spine. They are called facets or facet joints.

The average person is born with 33 vertebrae, stacked in a column. At birth, the spine is quite flexible. However, as we age, some of the small vertebrae near the base of the spine fuse together into what is called the sacrum, and below that are even smaller fused bones that form the tailbone or coccyx. So, by the time we reach adulthood, we have 24 vertebrae. Each vertebra has four facet joints. The joints are made up of small bone projections, the flat tips of which are lined with cartilage. One pair of projections connects with those on the vertebra above and another pair connects with the vertebra below. As with other joints in your body, the cartilage cushions the place where the bones meet. It also allows spinal movement to be smooth and painless.

What do facet joints do?

Every day you use your spine for many things involving posture, balance and movement. It must be sturdy yet flexible—but not too flexible, unless you’re a contortionist. It is the job of the facet joints to ensure that you can bend and twist while at the same time they limit how far you can bend and rotate in order to keep the vertebra from slipping away from each other. Thus, they are extremely important.

Facet joint pain

The bones of the spine itself form an inner tunnel that houses the spinal cord. The spinal cord is like a ropey bundle of nerves that form a trunk line of messages between the brain and the body. There are many nerves that branch off the spinal cord out to the rest of the body, and signals travel to and from all body parts—including the facet joints themselves. In fact, each facet joint is connected to two nerves that carry pain signals to the brain.

Normal movement of the spine is pain free as long as the spine is healthy. However, joints can deteriorate from wear and tear, injury, and from aging. The first thing to deteriorate is the cartilage, which wears down over time. This is called osteoarthritis. Remember that there are no blood or nerves in cartilage, so we don’t feel pain from thinning cartilage. However, as it wears away it no longer protects the bone tips so bone starts rubbing on bone. This can cause painful bone spurs to form. On top of that, the distance between the bones closes up, pinching or pressing on the facet joint nerves. When this occurs, it can progress from a dull ache to excruciating agony when moving or even sitting still.

How to treat facet joint osteoarthritis

There are many treatments for facet joint arthritis in its early stages. Over-the-counter pain relief products, heat or cold, gentle exercise to strengthen core muscles to support the spine, improved posture, physical therapy, etc. can ease discomfort.

If facet joint pain becomes more constant and unmanageable, a doctor may recommend injections containing anesthetic and steroids. Such injections can add months of pain-free living, but they gradually fade. They can be repeated about three times per year, but depending how long they last, there can be bouts of pain in between injections.

For permanent treatment of facet joint arthritis, the Sperling Medical Group offers a new noninvasive MRI-guided treatment called Focused Ultrasound. This noninvasive procedure precisely targets nerves at the joint. By deadening them without affecting any other nerve performance or spinal mobility, pain relief occurs very quickly and is permanent. To learn more, visit the Sperling Medical Group or contact us to set up a consultation.