Facet arthritis

Wear and tear of the facet joints cause facet arthritis. Patients who have facet arthritis experience more pain when leaning backwards. Strengthened core muscles prevent abnormal movement in the facet joint and decrease pain.

Sacroiliac joint dysfunction

In the lower part of the spine, the vertebrae fuses together to form a wedge shaped bone called the sacrum. The joint between the sacrum and the pelvis is the sacroiliac joint. Arthritis and injury can affect this joint. The pain is usually felt to the side and above the buttock. Sitting or lying for long periods increases the pain. Moving about seems to provide relief. Patients also find it difficult to lie on the affected side.


This is a condition that starts during adolescence. But it may only cause pain and symptoms much later on in life. As explained earlier, each vertebra has pegs at the back. There are two pegs on the top and two at the bottom. The pegs of the upper vertebra hook onto the pegs of the lower vertebra. The downward facing pegs of the lowest vertebra (L5) takes the greatest strain. This is because it holds the entire upper body. During adolescence, when there is a growth spurt, the body produces more cartilage. This cartilage then hardens into bone. In some youngsters from increased physical stresses, the cartilage separates. This may happen before the cartilage has hardened into bone. The risk is greater in youngsters who are very active. Usually youngster participating in gymnastics and other sports. The separation of the cartilage creates a defect in the ring. This defect is spondylolysis. The defect lies between the upward facing pegs and the downward facing pegs of the L5 vertebra.


Once the defect develops the L5 vertebra may slip forward over the sacrum. The slip of one vertebra over the other is spondylolisthesis. People with spondylolysis and spondylolisthesis may exhibit hamstring tightness.



Thinning of the bones is osteoporosis. The structure of bone is like reinforced concrete. Reinforced concrete contains cement and steel. The steel gives it the strength and the cement provides the stiffness. In the same manner bones consists of collagen and calcium. The collagen are the long thread like proteins which provide strength. Like the steel in reinforced concrete. The calcium provides the stiffness. Like the cement in reinforced concrete. Osteoporosis usually occurs in old age and mostly in women (after menopause). The bone loses both the collagen and the calcium. A good diet, sunlight and weight-bearing exercises will help. This should delay or decrease the incidence of osteoporosis. Severe osteoporosis can cause the back to curve into a hunch back.


At the tail end of the spine is the coccyx. Pain in the tail end of the spine is Coccydynia. Injury or the particular shape of the coccyx can cause pain. One of the simplest ways to address “Coccydynia” is to use a wedge with a Coccyx cut out. This will decrease the weight going through the coccyx. A doughnut ring is not helpful.


Whiplash is an acceleration deceleration injury. In collisions the occupants of the vehicle are subjected to forces. In a rear end collision the body is pushed forward. The head stays in its position causing the neck to bend backwards. But shortly after, the reflex movement of the body pulls the head forward. This now causes the neck to bend forwards. This sudden movement of the head to the back and then immediately to the front is whiplash. It is akin to the movement of the tip of the whip when cracked. Hence the term whiplash. The majority of the strain of the backward and forward movement of the head is taken by the neck. Imagine swinging a flower on its stalk. The greatest stress would be at the point where the flower is attached to the stalk. In whiplash patients may also experience pain in various other parts of the body. The shoulders, the head, the midback, the lower back. The temporomandibular joint (at the angle of the mouth) can also be affected. The effects following whiplash can vary. Evidence suggests that 96 to 98% of patients following whiplash recover completely. Active exercises and therapy are the roads to recovery. It is important to continue routine activity and do therapeutic exercises. Do not wear a brace for your neck following whiplash. There is evidence that a neck brace can make you worse.

Created and designed by Dr. George Ampat, Consultant Orthopaedic Spinal Surgeon

Disclaimer: Dr. Ampat has a commercial interest in Feet and Spine which sells ergonomic office chairs, sit-stand tables, orthotics and comfort shoes.