Thoracic Facet Syndrome
At every level in the spine, there is a three-joint complex that allows for spinal motion, stability and support: two facet joints and an intervertebral disc. Thinking of this system at each level as a ‘tripod’ is a great way to visualise how these three joints stabilise the spinal column. When the facet joints become worn out through constant use, they can become painful and restricted. We call this thoracic facet syndrome. These joints can become stiff inflamed and produce a considerable amount of pain. Typically this inflammation builds up with inactivity, so is usually worse in the morning and gets better throughout the day.
Cause of thoracic facet syndrome
Facet syndrome can be caused by sudden trauma, such as a whiplash injury, or by repetitive trauma, such as repetitive movements that inappropriately load and stress the spinal joints. Abnormal static postures can overload spinal tissues, including the facet joints, and cause inflammation and pain in these joints. More commonly, degenerative changes in thoracic spine can lead to abnormal stress and strain on thoracic facet joints. This results in increased loads on the facet joints, leading to microscopic tissue trauma, inflammation and then pain and restriction.
Risk factors for thoracic facet syndrome
The spine is responsible for supporting the weight of the upper body, which puts a tremendous amount of pressure on the spine, especially the joints and discs. Anything that adds to the pressure being placed on the spine can speed up the degeneration that leads to conditions like facet syndrome. This can include the following:
- Carrying extra body weight
- Poor posture and improper lifting technique
- Engaging in high-impact sports
- Traumatic injury
- An overly sedentary lifestyle
- Smoking, poor nutrition and excessive alcohol consumption, which decreases blood flow and the replenishment of important nutrients to joint cartilage.
Symptoms of thoracic facet syndrome
Thoracic (mid back or upper back) facet syndrome usually causes pain at the level of the issue. It gives midline pain along the spine where the pain facet joints are. Generally speaking, it is worse at the beginning of the day and is better as the back is warm by the end of the day. Positions that involve extension and rotation such as reaching back are usually worse and the patient might report tightness or restriction into some movements, particularly bending backwards. Rarely, deep breathing may feel restricted, as the ribs attach to the thoracic vertebrae, which might be restricted due to facet syndrome.
Treatment for thoracic facet syndrome
Treatment for thoracic facet syndrome is very successful with chiropractic and physiotherapy. Treatments will involve postural correction, soft tissue massage and joint therapies such as mobilisation and manipulation in order to restore normal motion to the affected joints. These treatments are typically combined with anti-inflammatory measures. In the vast majority of cases, chiropractic and physiotherapy measures are enough improve thoracic facet syndrome, should the pain or dysfunction persist our chiropractors or physiotherapists may recommend an injection into the facet joint to improve pain
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