Facet Injury After a Car Accident – Understanding Your Condition

At first, you may not even notice it. Everyone expects some slight aches and pains in their back from time to time, especially as they get older. A small twinge here or a little stiffness, there doesn’t seem to be anything to get worked up about. But then it grows more frequent and more severe. You may start noticing these symptoms every day, and gradually they become a regular part of your life. In time, you find yourself unable to tie your shoes, work in your garden, or even lift your grandchildren or children. You feel limited in the places you can go to and the things you can do because of the symptoms, and you give up your old hobbies and routine.

Auto accidents, and car crashes can cause injuries to the facet joints as a result of whiplash.

If you’ve been in a car accident you probably have already seen a doctor and been told that you’re suffering from facet joint injury. Putting a name to the culprit that has taken over your life may be a relief, but even with that knowledge, you still wonder, what is this disease? Why is it affecting me like this? And what can I do about it? Learning more about your condition is the first step to finding much-needed relief. 

Anatomy of Facet Injuries

To understand facet injury, you first have to have an understanding of the facet joint itself, including its structural makeup and the anatomy of the structure that it interacts with. The facet joints are located between vertebrae in the spinal column and operate as the “hinges” that allow them to move back and forth. In technical terms, it is the joint between the inferior or bottom articular process and the superior or top articular process.

This joint allows for backward and forward movement in the spine, and as such, it is vital to your ability to bend over, lean forward, or do anything else that involves turning your back. In addition to allowing backward and forward motion, facet joints guide the movement of the spine and keep it from bending too far to the right or left, providing stability in the back for twisting. It also keeps vertebrae from slipping over one another. 

Facet joints are an essential part of the spinal or vertebral column, which itself is part of an extremely delicate and complicated system that includes not only bone, but ligaments, tendons, muscles, cartilage, and more. The spine is made up of 33 vertebrae. Of these, 24 move independently and are called articulating vertebrae. They are located in the neck and upper back, mid-back, and lower back, known as the cervical, thoracic, and lumbar regions, respectively.

The remaining nine vertebrae are fused together and make up the coccyx, more commonly called the tailbone, and sacrum, both of which are located at the bottom of the spine. The articulating vertebrae can move back and forth because of the facet joints, which lie in between each pair. 

Also known as the zygapophysial or apophyseal joint, the facet joint is categorized as a synovial joint, the most common and moveable joint in the human body. This type of joint is characterized by the existence of a capsule containing lubricating fluid around the end of articulating, or moving, bones – in this case, the vertebrae. Essentially, it is the injury of the cartilage that covers the period of vertebrae that is defined as facet injury. This breakdown can occur when the lubricating fluid in the surrounding capsule dissipates. To understand this process more fully, it helps to understand what roles all of the main components play in a healthy joint.  

These components include:

• Articular capsule – This structure envelops the entire joint and is comprised of an outer and inner layer. The outer layer is made up of avascular white fibrous tissue, and the inner layer, which is called the synovial membrane, is a thin lining of soft tissue on the inside of the synovial joint that produces synovial fluid.

• Synovial bursa – The bursa is a small sac that contains synovial fluid. It serves to cushion the bones, muscles, and other types of tissue on a joint to lower friction and increase freedom of movement.

• Synovial fluid- This fluid has a consistency similar to a raw egg, and it serves to reduce friction between the bones in a joint. The synovial fluid is secreted into the joint cavity where it seeps into any pits or other irregularities the cartilage may have. In the facet joints, it forms a weak layer between the cartilage of the top vertebra and that of the bottom vertebra so that they can glide smoothly over one another. In addition to lubricating the joints, synovial fluid also allows the joints to absorb shock, and it becomes thicker or more viscous when under pressure. Lastly, the synovial fluid is responsible for transporting oxygen, nutrients, and waste to and from the surrounding cartilage.

• Articular cartilage –More flexible than bone and more rigid than muscle, cartilage is a connective tissue found in nearly every joint in the body. Articular cartilage is located at the end of bones, where they meet others to create a joint. In the spine, articular cartilage is what provides cushion and the lubrication at the facet joint where two vertebrae meet. Because it does not contain blood vessels, cartilage is unable to grow or repair itself as quickly as most other connective tissues.

 If the synovial fluid in the facet joint dries up and is no longer able to provide the lubricating layer between cartilage, friction can occur, and the cartilage weakens and inevitably breaks down. When the cartilage wears down, irritation and swelling occur, and nearby nerve roots can be compressed, leading to painful symptoms.

Causes and Risk Factors

Knowing the anatomy of the facet joint, and the details of how to facet disease occurs, you probably want to know why it happens. More importantly, you perhaps want to know, “Why me? What caused my facet joints to break down?” The answer is less clear than many would like. Several risk factors may contribute to the development of it and accelerate this wear and tear. 

These include:

• Age – As you’ll remember from the section above, cartilage is much less able to repair itself than many other types of tissue, and it’s also slower at doing so. It is so tricky that the body can wear cartilage down faster than it can regenerate it, so as a person gets older, they have less cartilage to cushion the facet joints. In addition, the cartilaginous spinal discs can also become thinner with age, putting even more stress on the facet joints. When the discs get to be so weak that the vertebrae are no longer sufficiently cushioned, it can affect the way two adjacent vertebrae align at a facet joint, and pain and other symptoms can result.

• Career – Those who are involved in jobs that are physically demanding, especially on the back, are more likely to develop facet joint disease, and at an earlier age. These activities increase the use of the joints and the potential for injury.

• Activity level – Similar to those with physical careers, if you lead a very active lifestyle, and especially if you play or have played rough sports, you may have put more stress and wear and tear on your back than a less active person.

• Car Accident – A car accident or other physical trauma can damage the cartilage and the joint itself.

• Obesity – As you might imagine, people who weigh more put more stress on their spines. This extra weight also results in a faster and more severe breakdown of the facet joints, which have a role in supporting this weight.

• Poor diet – Just as your eyes and muscles may not function as well without proper nutrition, the cartilage in your body can be compromised by a lack of the nutrients required to generate and repair it.

Facet Injury – Symptoms

While everyone experiences the condition differently according to their degree of injury and other factors, commonly experienced symptoms include:

• Pain – The defining characteristic of facet disease symptoms, pain can occur not only within the spine around the affected joint but also in other nearby regions of the body.

• Stiffness in the spine (guarding) – Since the joints are responsible for the back and forth movement, inflexibility can occur when they wear out.

• Tenderness–The area of the back where the affected joint is located can become sensitive to the touch in addition to the more profound pain generated by the condition.

Similar to those of many other spinal conditions, facet injury symptoms are felt in different locations depending on the region of the back in which the affected vertebra is located. For example, a worn-out facet joint in the neck or cervical spine, which includes vertebrae C1 to C7, presents symptoms in the upper back, neck, and shoulders.

An affected facet joint that’s located in the lower or lumbar spine, which includes vertebrae L1 to L5, causes symptoms that are felt in the lower back, and even in the buttocks and thighs. The pain from a facet issue differs from many other spinal conditions by the fact that it does not extend into the lower legs and feet.

With an accurate diagnosis derived from your symptoms, a physical examination, and potentially an MRI or CT scan, your doctor can explore options for treating your condition. Treatment will likely begin with any combination of a variety of simple, non-invasive techniques, like over-the-counter pain medications or specific stretches and exercises. For most people, these types of treatments can significantly decrease symptoms. But some sufferers will need something more.  

Facet Injury and Vertebral Motion Analysis by AOMSI Diagnostics

If you’ve already attempted several conservative, nonsurgical treatments that your doctor suggested to help find relief from your facet disease, but they’ve failed to produce relief after several weeks or months, then a Vertebral Motion Analysis by AOMSI Diagnosis may be the next step to determine the proper care to help your injuries.