Facet Joint Pain / Arthritis

kingrollo

Apologies I have covered the politics and struggles of me getting treatment for my ageing back in other threads. - But now want to concentrate on the injury/pain itself.

Basically I am 55 and since my mid 20's have suffered with facet joint problems and pain. Eventually I needed a steroid injection and this seem to calm everything down - educating myself about my back and enrolling in pilates/yoga classes gave me long periods of being active and totally pain free - around every 5 years I would have another major flare up - and would need an injection to calm it down.

Out of the blue it flared up again last September and a degree of wrangling I finally got to have another injection - but this time the relief has only lasted a few weeks, a MRI has shown very minor wear on one of the discs - and some facet joint arthritus, but the consultant considers my back normal for my age. - I think my options are as follows:-

1.To take hefty doses of co-codamol \ naproxen to keep me pain free and able to cycle and to hell with the damage these do

2.To push for nerve ablation of the facet joint nerves - basically this burns the nerves near the facet joint - so the messages of pain don't reach your brain

3.To adopt a more sedentary lifestyle - with yoga/pilates as my only exercise - try as I might I think this would lead to hefy weight gain

Tried, physio, acupuncture, core strength, Yoga - which I still do - it helps, but not enough to feel like cycling

Any experience \ thoughts welcome...

pilot_pete

Chiropractor, which I think I mentioned in another thread. I’m a few years younger than you, have suffered similarly since early twenties when a infanteer carrying too much weight over big hills and jumping off things and out of perfectly serviceable aeroplanes etc.

Get a decent one, you may find it revelatory. My pelvis, thorasic spine and neck all compensate trying to relieve the pain by adopting an out of alignment position. My (fantastic) chiropractor manipulates me back into some sort of correct posture over one or sometimes two sessions and I can live life relatively pain free for another 3 months or so.

The alternative is spinal fusion, which I am putting off for as long as possible. Like you, I’ve had the injections and given up on them as the last one only lasted for a few weeks and I have to have two weeks off work at the insistence of my aero medical examiner after each set of injections - just not worth it.

Good luck

PP

carnageasada

Have you considered an inversion table or a similar traction table via PT? I suffer from significant spondy and have been offered ablation as you mentioned, even fusion, which I abhor at this point in my life...

Don't know about your insurance, but mine paid for a Teeter brand inversion table and it's awesome, not entirely sure it'll provide relief, but allowing my spine to decompress daily has been what appears to be a game-changer for me.

kingrollo

Thanks guys - the inversion table looks interesting....

Think I am going to give a chiropractor a go - my mate has recommended one - the only things he is listed as an osteopath ....is that the same as a chiropractor ?

Wheelspinner

Osteopath a little gentler than a chiropractor in my experience, will work more on soft tissue and less on adjustments.

I've been trialling a different machine instead of an inversion table, mainly because those things make me dizzy and nauseous these days. It's called a "Nubax", but doubt they are available readily in UK. Dunno. It does help lower back for me, although that's not always my main problem.

I have neck issues from a broken cervical vertebra 7+ years ago to add to the general deterioration of age and wear. After 5 years of fairly unrelenting - if relatively tolerable - pain, I was persuaded to have the fusion surgery on C5 & 6 .

Far and away the single worst decision of my life.

If I could go back to how I was before that surgery tomorrow, I'd take it in a heartbeat.

carnageasada

Osteopaths focus specifically on joints, tendons, and the like... As @Wheelspinner said, the soft tissue aspects of our skeletal system.

Also, inversion does take getting used to, but if you are willing, you do adjust to the "head rush" and the benefits of this kind of decompression are immense. If you have the option for physical therapy, see if the have a traction table, same idea and is to decompress your spine, high and low, just to supplement what a chiropractor might be able to do.

kingrollo

It dead weird - in that lots of things seem to make the better - and you think 'ah cracked it' - then the pain returns - and what you did to make it better no longer work.

A couple of weeks back after a flare up - I started to do a lot of plank exercises - wow ! my back pain dissapeared - then it returned and the planks seem to have no effect.

Likewise a real sweaty 30 mins on an excercise bike - seemed to help - I thought it was the sweat softening everything up - then it stopped helping -

Strange...

kingrollo

Seen the consultant today - he has referred me to pain main management to be considered for nerve abalation

kingrollo

Osteopath appointment today - I wasn't overly impressed got different advice than from everywhere else.

1.Reckon my spine is out of line as I compensate for the ropey facet joint.

2.Reckons cycling will only make things worse due to my bulging disc

3.I should in the short term stop all yoga /pilates/ core workout/cycling - and only do 2 exercises - child pose and knee to chest.

Obviously 2 is a blow - but 3 I disagree with as things improve the more active I am. His theory is that any sort of backwards bending irritates the facet joint. He did some massage and cracking of my high spine which he says is stiff...

He was also very young and seemed nervous at one stage I thought he was going say "Sorry I am unable to assist" (He didn't)

Any thoughts...?

webboo

He has said all things you did not want to hear. I have no idea whether he’s right or wrong but if he had said the same things about what’s wrong with your back but it’s ok to carry on as before.
How would you feel.

kingrollo

Webboo wrote:

He has said all things you did not want to hear. I have no idea whether he’s right or wrong but if he had said the same things about what’s wrong with your back but it’s ok to carry on as before.
How would you feel.

He has said stuff I dont want to hear...true...but also he has said the opposite of every other health professional I have seen.

My fear is my back will get worse if I dont do activity.he will then tell me to resume and the improvement will put me back to where I am today....but £200-300 lighter...

webboo

kingrollo wrote:

Webboo wrote:

He has said all things you did not want to hear. I have no idea whether he’s right or wrong but if he had said the same things about what’s wrong with your back but it’s ok to carry on as before.
How would you feel.

He has said stuff I dont want to hear...true...but also he has said the opposite of every other health professional I have seen.

My fear is my back will get worse if I dont do activity.he will then tell me to resume and the improvement will put me back to where I am today....but £200-300 lighter...

It appears that you don’t believe he is being honest with you and he is just after making money off you.
It’s not going to work even if he’s right.
There is a saying that if you see enough specialists/ medics/ therapists eventually you will find one who tells you what you want to hear.

pilot_pete

kingrollo wrote:

His theory is that any sort of backwards bending irritates the facet joint.

Any thoughts...?

Err, how is riding classed as backwards bending?

PP

giropaul

I guess that quite a lot depends on your age, and a bigger picture of your general health.
I have advanced osteoarthritis in my shoulder and spine. The spinal breakdown creates sciatica type issues.
The professional advice from my consultant, GP and the GP surgery Pharmacist is that at my age ( late 60s) the benefits of riding using painkillers currently outweigh the side effect risks of the medication. I do feel very involved in the conversation; I’m hugely grateful to have such excellent practitioners.
For me, Naproxen and other NSAIDs cause muscle power issues ( confirmed by some current academic research)
So, it’s a decision around balance of risk and benefit. I have lost quite a lot of power since the osteoarthritis was identified - condition, age or medication I don’t know.
The medication does impose a discipline for riding ( lead in time for medication to kick in), number of rides/ week to avoid dependency issues, and keeping rides within the time when the medication is effective. However, I am riding and can do cope with the riding that matters to me.

kingrollo

Pilot Pete wrote:

kingrollo wrote:

His theory is that any sort of backwards bending irritates the facet joint.

Any thoughts...?

Err, how is riding classed as backwards bending?

PP

Well I have two issues (not uncommon apparently) - a bulging disc and facet joint arthritis - his point was the leaning forward will put pressure on the disc(s) thus making the disc problem worse. He sensed my enthusiasm for cycling and said I shouldn't push through pain - easier said than done, after a few minutes on the bike the endorphins kick in and the pain either goes or I don't notice it.

Separately he he said leaning back would close the facet joints. (not good)
I go to yoga and pilates weekly and do a daily set of core strength excises - I go to the gym and either do cross trainer or bike - then a set of core excercises.
He said I shouldn't be doing anything which causes my back to arch backwards - even a little bit - and that in the short term I should only do childs pose stretches - and knee to chest exercises. 2 lots of 3 daily.

Once I get going yoga/pilates/Gym/Cycling nearly always make me feel better - and other health professionals have said to keep active.

pilot_pete

His is one view. Lay off the bike for a few weeks and if you are no better then you may as well keep riding if you feel is does you good. You do have to weigh up the other benefits of the cycling such as cardiac fitness, wellbeing etc. You will be able to feel if cycling irritates your condition and/ or if not cycling significantly improves it.

PP

kingrollo

Webboo wrote:

kingrollo wrote:

Webboo wrote:

He has said all things you did not want to hear. I have no idea whether he’s right or wrong but if he had said the same things about what’s wrong with your back but it’s ok to carry on as before.
How would you feel.

He has said stuff I dont want to hear...true...but also he has said the opposite of every other health professional I have seen.

My fear is my back will get worse if I dont do activity.he will then tell me to resume and the improvement will put me back to where I am today....but £200-300 lighter...

It appears that you don’t believe he is being honest with you and he is just after making money off you.
It’s not going to work even if he’s right.
There is a saying that if you see enough specialists/ medics/ therapists eventually you will find one who tells you what you want to hear.

Ive never heard that saying ? .....where did you hear that ?

The general point he seemed to be making was if you do less you will get less pain. My problem is that I dont want to do less...and feel that doing less will only help in the very short term.

webboo

I think the idea of therapist shopping is quoted in Pain Free by Pete Egoscue. There is a chapter called The Perils and Pain of Doctor Shopping
In this book he suggests that although you may have pain in your shoulder for example the actually cause may be your hips are out of line so you need to get the muscles there to relax.
There are exercises for everybody area but there are some recommended for nearly every condition. I’m just looking at the exercises for wrist pain and one exercise is supine groin stretch. Which is laying on your back with one leg bent at the knee rest on something so it’s bent at 90 degrees. The idea is to tame the powerful hip adductor muscles.
It’s bit of a mixture of physio ex’s Yoga and the like.
I haven’t used the exercises for a while but I tend to dip in to it when my usually routine fails to resolve a problem.
I might be starting today

svetty

My experience is that if you pretty much carry on doing things as normal the body keeps reasonably supple and the brain learns to filter out the pain signals. I have several bulging discs and considerable facet joint degeneration....

Just avoid heavy lifting and keep your spine mobility going

kingrollo

The good news is the pain at the base of spine has gotten a lot better.

Did a few rides to and from work - then a couple of 30 miles rides - bad news the pain has no shifted to between my shoulder blades and my neck.
Not sure if this is too much too soon (not done much cycling since sept) or whether the problems I have in my lower back are also present higher in my spine. Booked to see physio next week - any points in the meantime ?

Ben6899

kingrollo wrote:

The good news is the pain at the base of spine has gotten a lot better.

Did a few rides to and from work - then a couple of 30 miles rides - bad news the pain has no shifted to between my shoulder blades and my neck.
Not sure if this is too much too soon (not done much cycling since sept) or whether the problems I have in my lower back are also present higher in my spine. Booked to see physio next week - any points in the meantime ?

A poor fit or lack of time on the bike can both cause these symptoms; don't necessarily attribute it to the other issues.

kingrollo

O/P Just an update

After much huffing and puffing I eventually got offered nerve ablation treatment on the facet joints. Basically they destroy the tiny nerves in your facet joints - this stops the 'go into spasm' messages getting through.

Fairly painless procedure and it seems to have worked.

de_sisti

I had the same problems in my back (inversion table didn't work for me). I saw videos on
youtube about streching glute and hamstring muscles (especially the glutes). Tried the
exercises (especially the glute ones) and my back problems were over. I have to do them
regularly though.

* https://www.google.com/search?q=figure+4+stretch&oq=figure+4&aqs=chrome.1.69i57j0l5.6084j1j8&sourceid=chrome&ie=UTF-8

* https://www.youtube.com/watch?v=RdEfvemvsrI

paterberg

kingrollo - just wondering how your back is faring since you had your ablation last autumn? I'm a similar age to you and had that procedure carried out a few years ago with mixed success.

kingrollo

paterberg said:

kingrollo - just wondering how your back is faring since you had your ablation last autumn? I'm a similar age to you and had that procedure carried out a few years ago with mixed success.

Quote - sorry for the late almost 2 years reply !!!

But it worked fantasticlly for me - close on 2 years releif.

But now I've discovered deadlifts - which to my utter amazement seem to keep the back pain at bay.

Wheelspinner

That ablation (or “denervation”) is on my options list. Specialist wants me to do yet another cortisone injection despite the fact the last two have done f^ck all, and pending result perhaps that nerve burning routine.

If *that* doesn’t work, there’s an op to try and clean out the osteophyte growth and arthritic calcification that’s pinching the nerves. Ya-frickin-hoo.

kingrollo

Wheelspinner said:

That ablation (or “denervation”) is on my options list. Specialist wants me to do yet another cortisone injection despite the fact the last two have done f^ck all, and pending result perhaps that nerve burning routine.

If *that* doesn’t work, there’s an op to try and clean out the osteophyte growth and arthritic calcification that’s pinching the nerves. Ya-frickin-hoo.

The ablation has a high success rate.
Daft as it sounds - deadlifts at the gym have helped me no end though.

kingrollo

Wheelspinner said:

That ablation (or “denervation”) is on my options list. Specialist wants me to do yet another cortisone injection despite the fact the last two have done f^ck all, and pending result perhaps that nerve burning routine.

If *that* doesn’t work, there’s an op to try and clean out the osteophyte growth and arthritic calcification that’s pinching the nerves. Ya-frickin-hoo.

The ablation has a high success rate.
Daft as it sounds - deadlifts at the gym have helped me no end though.

Wheelspinner

kingrollo said:

Wheelspinner said:

That ablation (or “denervation”) is on my options list. Specialist wants me to do yet another cortisone injection despite the fact the last two have done f^ck all, and pending result perhaps that nerve burning routine.

If *that* doesn’t work, there’s an op to try and clean out the osteophyte growth and arthritic calcification that’s pinching the nerves. Ya-frickin-hoo.

The ablation has a high success rate.
Daft as it sounds - deadlifts at the gym have helped me no end though.

Deadlifts unlikely to help me - issue is in the middle of my neck (C4/C5) :-)

I'm somewhat sceptical of the statistics quoted around outcomes from injection or even surgery. I was assured the fusion procedure I had was ~ 96% "successful" in reducing or eliminating the pinched nerves pain, yet it made no impact on the symptoms at all, not even for a short term benefit. The long term impact of that procedure is where I am now - worse off than before.

I've had 2 facet joint block injections and 2 foraminal block procedures, including a bilateral one. Zero benefit from any of them. I did have a cortisone needle in my elbow once that was effective.

I must be unlucky.. lol

Wheelspinner

Update: Had the facet block injection a couple weeks ago, got some half decent relief… for 2 days, and now back to as bad or worse than before. 😕

Neurology dude today tells me the ablation is realistically my last option. He didn’t seem overly confident of it’s effectiveness.