Massage & Bodywork


Issue link:

Contents of this Issue


Page 100 of 117

technique MYOSKELETAL ALIGNMENT TECHNIQUES Low-Back Z-Joint Pain Addressing Facet Joint Syndrome By Erik Dalton, PhD 1 2 3 Clients with nonspecifi c low- back pain may be experiencing mechanical wear and tear of the zygapophyseal joints, located in the posterior aspect of the lumbar spine (Image 1). These bony articulations are commonly referred to as facet joints, but the proper terminology is zygapophyseal joints or Z-joints—derived from the Greek words zygos, meaning bridge, and physis, meaning outgrowth. The Z-joints are lined with cartilage, lubricated in synovial fl uid, and covered by a tough joint capsule. When healthy, they allow smooth gliding and sliding while preventing excessive lumbar rotation. In the middle-aged and elderly populations, normal vertebral motion is often compromised, or an injury, repetitive movements, obesity, weak posture, and aging articular cartilage may change the way the Z-joints align and move on one another. Additionally, trauma combined with prolonged gravitational exposure causes thinning of the joint capsule, cartilage degradation, and accompanying bone spurs. Similar to knee arthritis, the changes in the physiology of the Z-joints make it diffi cult for the joint to move fl uidly, which often triggers an infl ammatory response. With chemically sensitized medial branch sensory nerves bombarding the spinal cord and brain with danger signals, the Z-Joint Pathology: Mechanical wear and tear of the zygapophyseal joints. Z-Joint Pain Provocation Test: Using soft palms, the therapist palpates the paravertebral tissues overlying the lumbar transverse processes and the client reports Z-joint tenderness. Sphinx Hyperextension Test: The client assumes a pain-free sphinx position and the therapist's soft palms apply very gentle pressure to each side of the lumbar spine. Record as a positive for possible Z-joint pathology if the client reports localized low-back or gluteal pain. back stiffens and may hurt during certain movements. Acute episodes of lumbar Z-joint pain are typically intermittent, generally unpredictable, and occur a few times per month or per year. Although standing may be somewhat limited, sitting seems to be the most provocative position. In acute cases, Z-joint symptoms typically localize to one side of the back adjacent to the spine. In chronic cases, diffuse pain may spread into the buttock, groin, or down the entire limb. Z-JOINT PAIN PROVOCATION TESTS In Image 2, I begin assessment by gently palpating the paravertebral tissues overlying the lumbar transverse processes. The Z-joints themselves are not manually palpable, but this maneuver is helpful in localizing and reproducing any point tenderness, which commonly accompanies Z-joint mediated pain. If the client reports localized unilateral tenderness, there are several confi rmation exams I've found helpful, especially the Sphinx Hyperextension Test (Image 3). HYPEREXTENSION TEST AND KEMP'S TEST In the Kemp's Test (Image 4), backward bending, rotation, and sidebending toward the affected side may elicit Z-joint symptoms. However, it's important to note that this pain provocation test may also implicate nerve root compression and sciatica symptoms. Sharp buttock and leg pain following a dermatomal pattern may suggest sciatica, whereas Z-joint irritation is suspected if the test reproduces the client's localized low-back pain. If unsure, several other tests, such as the Slump Test and Straight Leg Raise Test, should be clustered to confi rm your fi ndings. 98 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 2 0

Articles in this issue

Archives of this issue

view archives of Massage & Bodywork - MARCH | APRIL 2020