Qualified Knowledge on Back Care and Rehabilitation.

Back Pain and Pain Management

Doctors' Corner - Q & A

You will LOVE the opportunity to have an online Q&A to help with your back and joint problems. Post your questions here and watch for it to be answered right online. We will not post your Name or Email information.

Because of the large amounts of requests, only selected questions will be answered online.

General questions on back care and rehabilitation will be answered. No medical advice will be given here.

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Answers to questions we've received will be posted below.

I have been diagnosed with "facet joint syndrome" and after no long-lasting relief from pain blocks they are recommending radio frequency treatments.  I understand you don't give medical advice, but can you comment on this procedure or any other suggested for care of my back?

Answer: The procedure that you are referring to is known as a "facet rhizotomy."  As you may know, this involves using a probe under x-ray control to destroy some of the small nerve endings which enervate the facet joints.  It is used in unusually severe and persistent problems.  Briefly, the facets have failed to hold the posterior part of the vertebra in proper alignment with the adjacent segment.  Most of the time, there is also failure of the intervertebral disc, usually due to degenerative change.  This puts stress on the joint capsules which are loaded with nociceptors (pain fibers), which in turn signal the brain that something is amiss. 

It is not possible to give specific medical advice without the benefit of a thorough examination.  Having said that, the following comments are in general regarding yours or similar conditions.

In my opinion, all other options should be tried first.  These would include medical, such as non-steroidal anti imflammatories and injections, physical therapy, chiropractic, exercise, life style changes, etc.  Only after failing with all of these, would I proceed to rhizotomy.  The rhizotomy does not correct the cause of the problem, just prevents the brain from perceiving that something is wrong.  It is sort of like cutting the wires to the fire alarm after it goes off.  The alarm is shut off, but the fire rages on.  Many of these patients wind up with a bone fusion surgery, as degeneration of the disc is most likely the underlying cause. 

People who have not experienced even only temporary lower back pain cannot relate to what you are suffering through, yet alone understand that what you feel is on a daily basis.  I hope this is of some benefit and you find a solution to your problem. 

Michael J. Wittmer, D.C.     

What will cause your joints to lock up in your back?

Answer: I assume that when you say that the "joints lock up," you are referring to a situation where mobility is severely limited.  Obviously, there are varying degrees of this.  For example, normal flexion (forward bending) is considered to be approximately 90 degrees.  A patient with 50 or 60 degrees of flexion would not be considered "normal" but not in the condition that you refer to.  

We'll consider a patient with less than 10 degrees of movement as "locked up."  Usually, when this happens, there is a particular incident or activity that precipitated the condition.  For there to be that much limitation, the most likely problem would be a bulging or herniated disc.  The disc is like a jelly doughnut, with a gel like center called the nucleus and an outer, fibrous material called the annulus fibrosis.  The nucleus tears through a part or all of the annulus.  When this happens, there may be direct pressure on one or more of the lumbar nerves.  This also causes a misalignment of the vertebral joints that are towards the back or the spine, called the facet joints or zygopophyseal joints.  This is very painful.  In addition, as a protective mechanism, the muscles will spasm, which is also very painful.  

When the happens, professional attention is needed.  There are some serious complications that can be associated with this and the exact cause needs to be determined.

Michael J. Wittmer, D.C.

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