Question
I have mild arthritis in my facet joints most prominent in L4-L5.  Pain started in August of this year. I have seen a chiropractor since the end of August. I have had x-rays and MRI confirming this dx.  I have also had some PT which recommended back strengthening exercises. I have a massage 2x's a month.

As far as seeing the chiropractor...my back pain improved slightly with tx after about 6 tx.  It has stayed at this level and sometimes deteriorated. My pain stays at about a 4-5 daily on average. This past week I would say it has gotten worse..more back to the level I started at when I first started going about 7-8. My pain also moved with tx. Started lower back, moved mid back, moved into my hips, groin, thigh area, and now is back to my lower back/mid back area today. Yet, yesterday after tx I immediately felt it in my legs and hips.

I recently saw a Rheumatologist who feels stabilizing my back with a corset, doing some mild aqua therapy ( not PT), and massage is my best tx. He feels I have tried chiropractic long enough and that maybe it is irritating the arthritis more than helping it.  I have had 19 tx all together now with the DC.I spoke with my chiropractor who feels manipulation helps facet joint arthritis. I am also awaiting some test results to rule out psoriatic arthritis since I have a family hx. and other arthritic joints. I am 37 years old.

With these 2 different opinions of practitioners both with whom I respect I am looking for a 3rd voice.  Anything you would have to say about my case would be appreciated. Anything else I should consider.


Answer
Jenny,

"Improved slightly after six weeks" is not really all that great when it's just lower back pain without sciatica (nerve pain into the leg/calf/foot).   Facet joint arthropathy is not always correlated with back paln.  You need to determine if you have spine instability, where one bone moves around on the other.  One way to assume instability is the test presented in this article: "Interrater Reliability of Clinical Examination Measures for Identification of Lumbar Segmental Instability; Gregory E. Hicks; Arch Phys Med Rehabil Vol 84, December 2003).  Your chiro' can look this up.  Instabilty can lead to worsening back pain if too much passive manual therapy is provided and you are not exercising. Massage is not likley to change anything.    If the facets really are the cause of your pain, then an MD Physiatrist would be able to inject them with a "diagnostic block" of anesthetic/cortisone and you would feel immediate pain relief.   Joint manipulation is not the end-all for back pain, and research shows that if your back pain is not significantly improved within a few weeks, then odds are the treatment is off.  Also, there are different manual methods performed by chiropractors, so if you are only getting one thing done on each chiro visit, that could be another factor.   Please check through some of my responses to other questionners on this topic.  

'Hope this was helpful.

Dr. G