Several different authors estimate that 15 to 45% of all chronic low back pain is lumbar facet mediated pain (LFMP). The “gold standard” for diagnosis, which is recognized by most experts, is a series of two facet blocks using anesthetics which are active for different periods of time. An initial block is given and if the patient receives a significant reduction of pain a second block is performed. If the second provides a longer period of relief then it is assumed the pain arises from the facet. It must be mentioned when Schulte et al reported on the outcomes of 21 studies of LFMP using injection therapy, radiofrequency therapy or cryorhizotomy only 50% of patients achieved successful outcomes. If the pain generator in these cases were the facet joints, why were the results not more impressive? It is possible that the gold standard may be better described as the “best standard available” but not quite golden.

The high ankle sprain (HAS) is also known as an ankle syndesmosis injury. Some authors consider it a relatively rare occurrence, representing only 1% or less of all ankle sprains. Others consider it a much more common injury, especially in athletes. No studies were located that discuss prevention strategies or risk factors. However the mechanism of injury may provide some insight into risk factors.