Back pain and Lower Back Pain

The facet joints of the lumbar spine and the sacroiliac joint

The lower back facet joints and the lower back muscles

Let's return to the delicatessen that we discussed elsewhere in this lower back pain section and think again about our rather oversized sandwich. We still need to discover how the body manages to hold it all upright. Keeping our lumbar spine working in an upright posture can be a major challenge for the body.

The lumbar facet joints help. They sit down the back of the spine - the side nearest the skin. In fact, feel your own back as you read - can you feel the knobbly bits beneath the skin? Well just about an inch to either side of these bony bumps lie the lumbar facet joints or zygoapophyseal joints of the spine.

Sometimes the big muscles of the lumbar spine make it hard to feel the lumbar facet joints. These lower back muscles are called the erector spinae muscles and like the cauda equina they are aptly named. Their job is to hold the spine erect and they work like the guy ropes on a flag pole or the mast of a ship. By adjusting the tension in these muscles the body is able to hold the lower back in balance and stop us from swaying from side to side.

In a painful back these lumbar spine muscles can go into a cramp or spasm and they are strong enough to pull the person over to one side. You may have had this happen to you or seen it in a friend with low back pain. Therapists and doctors come across it quite often.

Other muscles - particularly our tummy or abdominal muscles - help the spine stay in good shape. If your abdomen is flabby then your spine muscles have to work harder. This can cause extra stress on the spine and often leads to back pain. The balance between all the muscle groups around the spine is very important. Recent interest in this muscle balance has produced new special exercises and stretches to treat people with troublesome back pain.

Anybody with lower back pain should work hard to keep their muscles in good shape. Healthy muscles will make future problems less likely.

A word of caution though - always seek the advice of a chartered physiotherapist or qualified fitness instructor first. If you do the exercises in the wrong way then you might make things worse, not better.

The joints of the spine

As you now know, the lumbar facet joints lie beneath the big erector spinae muscles. Each vertebra of the spine joins to the one above and the one below it and there are joints on both sides of the body. These are called the facet joints of the spine.

Like many other joints they have a little bag around them called the capsule. Inside is a slippery fluid which acts like the oil in a hinge, allowing movements to occur without friction building up. This fluid is called synovial fluid and it is made by the spongy lining of the joint surfaces - called the synovium.

These joints have nerves in them and are a common source of pain.

The joints and the discs work closely together and help each other support the bodies weight. If the disc becomes diseased then the joints need to work much harder and may show changes of wear and tear.

There's more about lumbar facet joints on this website - follow the links below or use the site search function.

The sacroiliac joints

The sacro iliac joints can also cause trouble. These are the big joints between the base of our backbone and the bones of the pelvis. The lowest bit of our back is called the sacrum, the big pelvis bones are called the iliac bones and the joint is called the sacro-iliac joint. Logical really isn't it.

These are big joints. When seen from the side they look a bit like the shape of the ear. You can see this ear shape in the picture above. The two bones fit together very snugly and the joints are held very tight together by tough gristly ligaments.

Problems in the sacro-iliac joints are six times more common in women than in men. Female hormones, especially during or after pregnancy, can soften the ligaments and loosen the joints. This makes a woman's sacro-iliac joints less stable than a man's and results in more problems with pain.

As the years have gone by science has discovered a lot about the way the spine is constructed. We know how it all fits together, how it gets its nerve supply and how pain messages are sent to the brain. Recently , we have begun to learn the way the joints change their movement when things go wrong and what can be done to help this. But, even with all this knowledge, it can still be difficult to be absolutely sure which bit of the spine is at fault in a patient who has pain. Other sections in this website will explain why this is so.

Page Links for lower back pain pages

Lower back pain
What causes back pain
How the spine nerves work
Facet Joint Pain - Sacroiliac Joint Pain
Back pain, disc pain and disc degeneration
lower back pain and the lumbar facet joints
What is Lower Back Pain
Why is my back sore?
Lower Back Pain Treatment and Referred Pain
First aid treatment measures for a low back pain attack
Manipulation Treatment for Back Pain
Acupuncture treatment for lower back pain
Back Pain Treatment

The Cameron Medical Website has a huge amount of content on issues related to joint pain, arthritis, back pain and other orthopaedic or joint problems. Most of it is written by Dr Cameron specially for this website. Click here to see what's available.

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