“Where does the pain come from?” is probably the most common question we hear as chiropractors. Frequently, the patient is not told the answer to this simple question. This is because there are many structures in the low back that share a common nerve supply. Hence, the feeling arising from those structures is located in the same area of the back. For example, the back portion of the disk, the facet capsule, and some of the deep muscles in the spine are all innervated by the same nerve and therefore hurt in a similar location. The only way to try to isolate the pain generator is to inject a local anesthetic to block the pain. This is because the chiropractic treatment approach is similar regardless of the exact tissue that is involved. It DOES matter in cases where pain radiates down the leg caused by a herniated disk vs. a localized pain in the back that doesn’t radiate. Hence, chiropractors will work hard to differentiate these two distinct types of conditions as the treatment is definitely different.
Facet Joint vs Herniated Disk
In 1995, the Quebec Task Force recognized the importance of this distinction and recommended all healthcare providers concentrate on differentiating the nerve root / herniated disk case from low back pain. In the model below, the arrow and pen point to the two most common structures that cause the herniated disk and the facet joint.
The facet joint, when sprained/injured, hurts worse when bending backward and feels good bending forwards. This is exactly the opposite for the herniated disk. Bending backward helps reduce pain and often reduces shooting leg pain as well. Bending over even a little can create a sharp stabbing pain in the back that may shoot down the leg. There are variations of this and BOTH the disk and the facet can generate pain at the same time.
