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PHYS THER
Vol. 88, No. 1, January 2008, p. 137
DOI: 10.2522/ptj.2008.88.1.137.1
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Letters and Responses

On "Indicators of lumbar zygapophyseal joint pain ..." Wilde et al. Phys Ther. 2007;87:1348–1361.


I commend the authors1 on utilizing the collaboration of the medical and physical therapy professions in an attempt to seek common ground with respect to this less-than-definitive clinical entity. Table 3, number 11, "Pain in extension, lateral flexion, or rotation to the ipsilateral side," mentions that "maximal compression of LZJ [lumbar zygapophyseal joint] surfaces occurs with these movements."1(p1356) However, with respect to rotation, the lumbar facet receiving compressive loads is the contralateral facet, or the facet on the side opposite the direction of rotation (eg, the left facet with right rotation).2 The load occurring at the ipsilateral lumbar facet is tensile (the left facet with left rotation).2 Therefore, pain at the ipsilateral facet with rotation may be due to hyper-trophy of the facet, allowing for stretch of the joint capsule,3 traction of a fibrotic capsule adhered to the cartilage surface, or traction of fibrotic synovial folds adhered to neural structures.4

Furthermore, the research by Yang and King5 mentioned by the authors does not explore compression with lateral flexion or rotation but only compressive loading of the lumbar facet in extension. Interestingly, their proposed mechanism of low back pain involves stretching to the lumbar facet capsule under high loads in extension due to the fulcrum effect of the inferior spinous process on the pars interarticularis of the vertebrae below and not necessarily due to the compression through the facet itself. However, compression of subchondral bone of the lumbar facet may be the source of low back pain.3,6 Despite the experts in the study (not the authors) providing justification for indicators of LZJ pain, it is necessary to make these points for future discussion and research on clinical signs and symptoms of LZJ pain and its proposed mechanisms.

Renee M Strobl

RM Strobl, PT, is a Physical Therapist at Beaumont Hospital-Grosse Pointe, St Clair Shores, Mich


  Footnotes
 
This letter was posted as a Rapid Response on November 2, 2007, at www.ptjournal.org.

References

  1. Wilde VE, Ford JJ, McMeeken JM. Indicators of lumbar zygapophyseal joint pain: survey of an expert panel with the Delphi technique. Phys Ther. 2007;87:1348–1361.[Abstract/Free Full Text]
  2. Shirazi-Adl A. Nonlinear stress analysis of the whole lumbar spine in torsion—mechanics of facet articulation. J Biomech. 1994;27:289–299.[CrossRef][Web of Science][Medline]
  3. Beaman DN, Graziano GP, Glover RA, et al. Substance P innervation of lumbar spine facet joints. Spine. 1993;18:1044–1049.[Web of Science][Medline]
  4. Giles GF, Harvey AR. Pathoanatomic studies and clinical significance of lumbosacral zygapophyseal (facet) joints. J Manipulative Physiol Ther. 1992;15:253–256.
  5. Yang KH, King AI. Mechanism of facet load transmission as a hypothesis for low-back pain. Spine. 1984;9:557–565.[CrossRef][Web of Science][Medline]
  6. Dunlop RB, Adams MA, Hutton WC. Disc space narrowing and the lumbar facet joints. J Bone Joint Surg Br. 1984;66:706–710.[Web of Science][Medline]

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This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Strobl, R. M
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Strobl, R. M
Related Collections
Right arrow Injuries and Conditions: Low Back
Right arrow Evidence-Based Practice
Right arrow Tests and Measurements
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
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