One common but rarely mentioned cause of Sciatica and Disc pain can be the facet joints in your spine. People will talk about bulging discs, arthritic changes, piriformis muscles and other causes but very few therapists talk about the facet joints.

There is good reason for this as facet joint problems are thought to cause more neck pain or local central back pain and that your disc is the typical thing that causes problems that go beyond the central area like Sciatica. There is a relation however and the physiotherapist Mulligan has a really good explanation that I will try and paraphrase.

If you imagine a joint in your spine as two books (representing vertebra) with a semi deflated ball between them (representing the disc). If you squeeze the books together at one end, the ball becomes the shape of a wedge and may bulge out the other end. This is the traditional view of disc herniation. However the ball may not have bulged out beyond the edge of the book. If all it did was become bigger at the end opposite the one you pushed down then there would be no herniation, this is what you would expect with joints in the spine working normally.

What happens however with this normal movement if you don’t let the two books move apart at the end opposite the one you are compressing. The ball has to go somewhere as you have squeezed the books together at the other end so the ball ends up bulging out. This is the idea that if the facet joints in your spine are not working as they should it can cause you to have disc problems and maybe sciatica.

Once the facet joints are opening and closing as they should then there is space for the disc and it doesn’t have to bulge out and irritate nerves. There are various ways to resolve facet joint dysfunction. Chiropractic adjustments that specifically target the joint are very effective. Sometimes facet joints respond favourably to mobilization (I particularly like Mulligans movement with mobilization techniques) and additionally specific exercises e.g. some of McKenzie’s exercises. Positional release techniques and muscle energy techniques also really compliment these other approaches.

Recently in my clinic I have found the Arthrostim to be particularly effective. It is a machine that vibrates about ten times a second sending impulses into the area that is being treated. The vibrating action works to free up locked facet joints and because the force is low its virtually pain free.

If you have neck or back problems its worth asking your healthcare professional if facet joint problems could be the cause of your problems.