T Nation

L4/L5 Facet Joint Hypertrophy & Spasms


Hello all,

I'm hoping someone can help me out here. I have a mild diffuse bulge at L4/L5. My doc said it isn't that bad but the facet joint hypertrophy at L4/L5 is what is really causing my low back pain and radiculopathy. Been going on for about 8 months. 7 months of PT hasn't helped much at all.

I've read several posts where BBB and Andersons have weighed in. Incredibly helpful. I have just finished McGill's book (and started the exercises) and Cressey's Assess and Correct is on it's way.

However, I'm needing something effective for the muscle spasms so I can start building some stability. I'm hoping Andersons or someone who he has helped reads this and can help me out. In several of his posts he says things like: "I have some movements and stretches that rapidly helped" and "small movements deliberately contract muscles in spasm, triggering them enough to subsequently relax (like QL and piriformis)" and "the real magic comes when you coordinate the contraction of an underactive muscle with the contraction of a spasmed muscle and then release together".

I need this! Not sure I can really fire those spasming muscles correctly to start stability training.

Any help is much appreciated.


Do McGill’s curl up, side plank, and bird dog. Regress them however you need to but do them 2-3x a day. Temporarily (or forever) stop flexing your lumbar spine. 7 months of PT is a long time for no results.


Thanks, I just started those but only doing them once a day. I’ll bump up to 2-3X/day.

Long story on the PT. In the beginning I didn’t have any sciatica pain, just low back pain. About a month into the PT doing mostly MacKenzie style (extension) exercises the sciatica came on. After the recent MRI findings, I attribute that to the facet joint hypertrophy hitting that nerve root while in extension. Doc and PT thought is was just a herniated disc at first.

The onset of the sciatica stumped the PT so I switched after another month. I originally went to him because he is also a CSCC.

Got some relief from the second PT but then in early July I was changing a flat tire and had just the slightest bit of flexion (without bracing the core) while putting the tire on the studs. Back to square one but no progress at all over 2 months now. After reading McGill I have realized that no one has really even tried to address the posture (flexion) issue or really the spine stability issue with me yet.