Joints of the spine

Joints of the spine: Facet joints


Having discussed what a disc it seems obvious to talk about the joints that lay either side of the disc; the facet joints.

These are essentially designed the same from the neck to the bottom of the back but vary on the angle they sit to allow different ranges of movement to occur.  When all are working as they should, they allow the spine to move in every way imaginable. 

Facet joints can cause problems when they stop moving.  This could be due to a number of reasons.

Because they move continuously in day to day life they can wear out like any other joint.  The cartilage that lines the joints can break down becoming thinner and that is when pain and inflammation can occur.

Even though it doesn't necessarily press on a nerve the pain can refer into the legs or arms via a method called referred pain. In response to this wearing process the joints actually enlarge as the body places extra bone around the area to help. This can in turn cause pressure on the nerves leading to pins and needles and numbness. 

This degeneration process is termed arthritis or spondylosis when it is specific to the spine. 

Sometimes these facet joints can be perfectly healthy but just get 'stuck'. This can occur especially in the neck and lead to a sudden loss of mobility and a lot of pain.  Luckily with treatment these settle quickly and you can go back to normal life a few days later.

What is an intervertebral disc?

What is an intervertebral disc?

A lot of our time is spent at the clinic talking about discs and different states they can be in, but what is a disc?

A disc is a fibro-cartilaginous structure that are situated between the vertebrae, the bones of the spine. They are located from the bottom of the skull right the way down to the tail bone. The purpose of the discs are to provide a shock absorbing system and to allow the spine to move.

The discs themselves have two parts to them; the outer part is called the annulus fibrous and the central part is the nucleus pulposus. Think of a jam do nut, the outer edge is the dough (the annulus), and the central part is the jam, (the nucleus).
 

Both parts of the disc contains water but more so the nucleus. This water content varies through the day. That is why you are slightly taller in the morning! The discs ability to hold water decreases with age as the discs become dehydrated. Amongst other things this contributes to the loss of height with age.

The disc is just part of a complicated system of the spine that allows us to do our daily activities.

We will discuss other parts of the spine and what happens when things go wrong in future blogs!

Why do we ask so many questions?

Sometimes when new patients enquire about an initial appointment they can be surprised that it takes an hour.  The reason for this is we need to assess the background to your injury and work out how best to help you.

Symptoms that appear to be a simple strain or muscle pull can occasionally be something much more serious.

Many of our patients are not seen by a GP before presentation.  Even if you have seen your doctor before coming to the clinic we do not have access to your medical records and are reliant on you telling us what the doctor or other specialist thinks, or has previously investigated. 

Some of our questioning may seem irrelevant but it all helps us build a picture of what your tissues, joints and muscles go through on a regular basis and guide us to help you in the best way we can.

If you have had any investigations such as an MRI scan, then bring in any reports or any other information you have.  Also a copy of any prescription medication you take.

Ice Vs Heat

Ice vs heat:

We DO NOT recommend the use of heat on your injury.

There is always a risk with heat that you can damage the skin over the injury and make further treatment difficult. Heat also tends to create more swelling of the area, this creates more pain and limits your mobility. Heat makes the area more sensitive, giving you a feeling of more pain.

We recommend the use of ICE on your injury.

We do this for several reasons.

When an injury is new it tends to bleed, this will lead to inflammation, putting ice on the area is thought to reduce the amount of bleeding and limit the amount of damage caused by the inflammation.

Ice is also a very good painkiller. The use of ice on an area will reduce the pain and discomfort that you feel.

It is recommended that an area that has been injured is moved as soon as possible after injury if it is safe to do so , the use of ice will help this.

Ice has been shown to have an effect on the area surrounding an injury by reducing muscle spasm.

The use of ice reduces the pain, reduces muscle spasm, reduces the amount of swelling and allows you to move the area sooner, allowing the area to recover faster and get you moving again.

The Safe Use of Ice.

Ice should never be applied directly to the skin. This could case “an ice burn” basically frost bite.

Ice should not be placed directly over a nerve as this could cause injury.

You should place a damp thin cloth between the skin and your ice. A damp tea towel or “J Cloth” is ideal.

Your ice should be in small chunks not a solid block, a bag of frozen peas is just about ideal ! Use one large or two smaller bags to thoroughly cover the area.

Crushed ice placed in a thick walled polythene bag also works well.

The ICE does not need to be as cold as possible, if the surface of the ice is slightly damp indicating the ice is melting within a few seconds of taking it out of the freezer is ideal, very cold ice such as from a very cold commercial freezer is TOO COLD and will cause damage to your skin.

The ice needs to be “pressed” against the damaged area, so you can wrap a towel around the area to compress the bag of ice against your skin.

Procedure

• Take your ice from the freezer and give it a few minutes, bash it about so that the peas break up and allow the bag to mould.
• Place your damp cloth on the skin followed by your bag if ice.

• Now wrap all of this or cover with a large towel to stop the room temperature melting the ice.


• Look at the clock, you need your ice on for between 10 and 20 minutes. If you use the ice for too short a time you will not get the benefit. If you use the ice for too long you can cause damage.

By the end of your ice session the area will probably be very red, this is normal, the skin will feel cold ! But should not be numb.
After you remove the ice you can put the bag back in the freezer, ready for the next use.

• Now it is advisable to gentle move the effected area.

• Start with very small movements and gradually increase the range, but do so very gently as the area will not be as painful and you do not wish to do more damage.

It is thought that your ability to move the damaged area after the ice is one of the best effects, it is thought to allow the area to keep flexible, prevents the formation of scar tissue and stimulate the tissue to grow in the correct way.

The area will warm over the next 15-30 minutes.

• You can repeat the ice every 2 hours.

YOU MUST NOT use ice just so that you can carry on, you will do more damage.

Activity after ice should be very gentle and controlled.

Some tissues such as tendons and ligaments recover very slowly – do not try and rush.

If your condition would benefit from the use of heat we will let you know this.

As a rule always use ice initially, never heat. 

After the injury has been professionally assessed, you can use heat if advised to do so.

If you have any concerns please ring and get advice BEFORE YOU USE ICE.

Patients with Reynaud's or Rheumatoid disease should not use ICE.

 

 

 

 

Are you sitting comfortably...?

People these days no matter what their occupation spend more and more time in front of a computer.

If you work in an office environment there is normally someone who is responsible for setting your computer up right whether that is having someone physically check your set up or a sheet of paper that you use as a guide. 

What happens when you get home?

Many of us have access to laptops, iPad's or similar or smart phones which draw you in for hours at a time surfing the internet.

All that hard work during the working day sitting up straight, not holding the phone in-between your ear and your shoulder is then potentially ruined when you come home and sit twisted onto the nice soft sofa.

Often we sit on one side of the sofa or have a particular chair we prefer so this pattern of twisting and poor posture is repeated each day. 

Today I have seen a gentleman that was complaining of golfers elbow (pain on the inside of the elbow) and on questioning we discovered that he habitually holds his arm across his body in the evening contributing to a shortening of his biceps muscle which is likely to be affecting his elbow.

Another lady I have seen recently always leant on the right side of the sofa arm with her elbow which, over time, lead to compaction in the shoulder joint.  

For the few seconds it takes just make sure you're sitting straight without a twist in the spine before watching your favourite soap.