What Are Facet Joints?
Facet joints (also called zygapophyseal joints) are small joints on either side of each vertebra. They guide and limit spinal motion while providing stability.
You have facet joints throughout your spine—cervical (neck), thoracic (mid-back), and lumbar (low back). The lumbar facets are most commonly symptomatic.
What Is Facet Joint Syndrome?
Facet joint syndrome is pain originating from one or more facet joints. It's estimated to cause 15-45% of chronic low back pain and 25-65% of chronic neck pain.
Despite being so common, it's often overlooked because symptoms overlap with disc problems and other conditions.
What Causes Facet Joint Problems?
Degeneration (Most Common)
Normal wear and tearCartilage breakdownOsteoarthritisMore common with ageOther Causes
Injury or traumaPoor postureObesityRepetitive stressDisc degeneration (puts more stress on facets)SpondylolisthesisSymptoms
Classic Pattern
Lumbar facet pain:
Low back pain, often one-sidedPain into buttock or back of thigh (not usually below knee)Worse with extension (bending backward)Worse with twistingStiffness after restBetter with movement (once warmed up)Better with flexion (bending forward)Cervical facet pain:
Neck pain, often one-sidedPain into shoulder or upper backHeadaches (especially back of head)Worse looking up or rotatingMorning stiffnessWhat It's NOT
Doesn't typically cause true radiculopathy (nerve root compression)Usually doesn't go past knee (lumbar) or past shoulder (cervical)No neurological deficits (weakness, numbness)Diagnosis
Challenge
There's no single test that definitively diagnoses facet pain. Diagnosis is based on:
History and symptom patternPhysical examResponse to diagnostic injectionPhysical Exam
Pain with extension and rotationTenderness over facet jointsAbsence of neurological findingsImaging
X-rays:
May show facet arthritisBut many people have arthritis without symptomsMRI:
Better detail of joints and soft tissueSame caveat—findings don't always correlate with painDiagnostic Injection
The gold standard:
Numbing medication injected into facet joint or nerveIf pain significantly relieved = facet source confirmedAlso therapeuticTreatment
Conservative (First Line)
Activity modification:
Avoid prolonged extensionModify activities that aggravateDon't stay in one position too longPhysical therapy:
Core stabilizationFlexibility workPosture correctionManual therapyMedications:
NSAIDsAcetaminophenTopical agentsExercise Approach
What helps:
Flexion-based exercises:
Knee-to-chest stretchesCat stretch (arching back up)Prayer stretchCore stabilization:
Dead bugsBird dogsPlanksHip flexibility:
Hip flexor stretchesHamstring stretchesWhat to limit initially:
Extension-based exercises:
Prone press-upsCobrasBack bendsHeavy loading:
Heavy squats and deadliftsOverhead pressingManual Therapy
Spinal mobilizationSoft tissue workOften provides reliefInjections
Facet Joint Injections
Corticosteroid + local anestheticDirectly into jointDiagnostic and therapeuticRelief varies (weeks to months)Medial Branch Blocks
Numbs the nerve supplying the facetMore diagnostic than therapeuticPrecursor to ablation if effectiveRadiofrequency Ablation (RFA)
For lasting relief:
Heat lesion to the nerve supplying the facetDone after positive diagnostic blocksPain relief typically 6-12 monthsCan be repeated when pain returnsWhen Surgery Is Considered
Rarely
Facet syndrome alone rarely requires surgery.
Exceptions
Part of larger degenerative problemAssociated instabilityFailed all other treatmentsLiving With Facet Syndrome
Daily Management
Avoid sustained extensionMaintain movementCore strengtheningRegular stretchingWork Modifications
Avoid overhead work when possibleTake position breaksErgonomic setupLong-Term Outlook
Usually manageableFlares may occurRFA available if conservative measures insufficient
Facet joint pain is common but often missed because there's no definitive test. If your back or neck pain is worse with bending backward and rotating, and better with bending forward and moving, consider facet joints as the source. Exercise, posture, and potentially injections or ablation can provide significant relief.