Medical treatments for FACET SYNDROME
Treatment of facet syndrome depends on the phase of treatment. During the acute phase, physical therapy, anti-inflammatory medications and muscle relaxants are useful. Physical therapy includes instruction on proper posture and body mechanics in activities of daily living that protect the injured joints, reduce symptoms, and prevent further injury. Positions that cause pain are avoided.
Bed rest beyond 2 days is not recommended because this can have detrimental effects on bone, connective tissue, muscle, and the cardiovascular system.
Superficial heat and cryotherapy also may help relax the muscles and reduce pain. In addition, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can also be administered. At this point, spinal manipulation and mobilization can also be attempted to reduce
During the recovery or rehabilitation phase, physical therapy is very important. Once the painful symptoms are controlled during the acute phase of treatment, stretching and strengthening exercises of the lumbar spine and associated muscles can be initiated. Stretching of the hip flexors, hamstrings, hip internal and external rotators, and lumbar extensors is essential because these muscles may have been inactive secondary to reduced activity by the patient.
As with most diseases that affect the spine, strengthening of the abdominal and gluteal muscles can prove particulary useful. Strengthening maneuvers must emphasize flexion, neutral postures, and pelvic tilt, all in an effort to reduce compression of the facet joints. Pelvic tilt maneuvers can help reduce the degree of lumbar lordosis, and they are to be performed with knees bent while standing, legs straight while standing, and while sitting. Flexion-based exercises are avoided if hypermobility or instability is suggested or if the maneuvers increase LBP. Additional activities can include stationary bicycling and treadmill ambulation on an incline.
Facet joint injection with corticosteroids and a local anesthetic is one of the interventional procedures performed.
The long-term benefit of intra-articular injection remains controversial. Similarly, radiofrequency rhizotomy, or coagulation of a portion of the sensory neurons supplying the facet joints, also is controversial.
Ongoing treatment involved strengthening of the muscles of the back and abdomen and range of motion.
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