Osteopathy: Joint Restriction

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Joint Restriction

A facet joint is the anatomical name for a gliding joint between two vertebrae. These joints allow the vertebrae working together as the spinal column to move in various directions whilst retaining stability and alignment. Around the facet joints are joint capsules, which contain the synovial fluid, which helps lubricate the joint. The vertebral joint is held in its normal configuration by ligaments, which provide a balance between mobility and stability. The facet joints nerve supply is via a branch of the nearest spinal nerve root. These nerves report and respond to stimuli such as pain, inflammation, and muscle tension, forming a neurological feedback loop to the brain via the spinal cord. Surrounding the vertebral column is the muscles, which produce and control spinal movements. The deeper paravertebral muscles produce small intervertebral or segmental movement whilst providing the main stability in the spine whilst the more superficial muscles produce a grosser range of spinal movement. The abdominal muscles also play a part in spinal mechanics, providing care stability, i.e. contributing to the balance of mobility and stability of the back muscles in everyday life.

Facet restriction has many causes but will most likely be caused by compound movements such as bending forward whilst bending or turning to one side. The resultant strain on the joint complex can result in stretching or tearing of joint capsule and ligaments with a reduction in space between the two joint surfaces. This together with resultant protective muscle spasm produces a reduction in joint movement. The resultant inflammation and tissue damage stimulates pain receptors in the surrounding tissue, which in turn stimulate pain nerve fibres. These fibres send stimuli to the brain via the spinal cord resulting in the perception of pain. Gross spinal movements can be reduced in certain directions i.e. directions which require the joint to open up or close fully. The patient with a strained facet joint will generally find that small everyday movements are still possible provided that the joints above, below or to the side of the affected joint are working well. In effect, the more subtle and flexible we are within the normal range, the better our ability to compensate and deal with these types of trauma.

Other factors involved in producing or predisposing factors include:

• Degenerative changes in the intervertebral discs, which bring the two surfaces of the vertebral joint closer together than normal.
• Joint hypermobility whereby the balance of joint stability with mobility is reduced due to ligamentous laxity.
• Osteoarthritis of the facet joints which reduces the range of movements in the facet joint.
• Occupational postural hazards such as repeated loading of the joints in extension.

Osteopathic treatment of restricted joints is both safe and effective. The osteopath will take a full case history and perform an osteopathic examination to find a viable working diagnosis. This is then explained to the patient and once they understand the nature of the problem and give their consent, treatment then begins. The treatment will obviously vary depending on the nature and location of the injury, but will generally consist of soft tissue techniques and a variety of anticulatery and manipulative release techniques. Soft tissue techniques release the tension held in the surrounding muscles whilst also helping to reduce any inflammation present. This will result in ease of symptoms and allow one affected joint to be stretched and released thereby returning it to its normal healthy range of pain-free movement.

Advise is given on improving posture whether general or occupational, movements and positions that will increase or decrease the symptoms, anything that can help the patient help themselves. Stretching exercises can also be incorporated into the advice. In effect, the best treatment includes education - why and how the injury was sustained, how to avoid it happening again, what eases/increases the symptoms and why, what can the patient do to help themselves.

Sean Durkan BSc (Hons) Osteopathy
140, Harley Street
London W1G 7LB
Tel 07880 746077