Facet joint pain comes from the small paired joints at the back of your spine, one on each side of every level. It usually feels like a deep ache on one or both sides of the spine, WORSE when you lean back or twist, and stiff first thing in the morning.
It’s a common cause of long-lasting back pain.
In people with low back pain that has gone on for months, the facet joints are thought to be the main source in somewhere between about 1 in 7 and 2 in 5. The same joints can cause neck pain too.
Exercise and staying active come FIRST. Needle treatments are for pain that won’t settle, and only after a numbing test has shown the facet joints are really the problem.
What the facet joints are
- Small hinges at the back of the spine. Each vertebra, the bones of your spine, links to the one above and below through a pair of facet joints. They guide how your spine bends and twists
- They’re lined with cartilage, like your knee or hip, so they can wear and get arthritis the same way
- Each joint has its own small nerves, called medial branch nerves. These carry the pain signal, and they’re the target for testing and treatment
Symptoms of facet joint pain
- Ache beside the spine. On one side or both, rather than right in the middle
- Worse leaning back or twisting: reaching up to a high shelf, looking up, standing for long spells, or turning to reverse the car
- Stiff in the morning or after sitting still, easing once you get moving
- Low back: pain can spread into the buttock, hip, groin or back of the thigh. It usually stays above the knee
- Neck: pain can spread to the back of the head, the top of the shoulder or between the shoulder blades. Neck facet pain is common after whiplash
- Usually no pins and needles. Numbness, tingling or sharp pain running down to the foot points more toward a pinched nerve, as in sciatica
How facet joint pain is diagnosed
There’s no scan that proves it. Most people over 60 have some facet wear on X-rays or MRI, whether they have pain or not. See degenerative disc disease for why scan findings and pain often don’t match.
- Your story and an exam. Where it hurts and which moves set it off narrow things down. They can’t confirm it on their own
- Ruling out look-alikes. The SI joint, a disc and the hip can all hurt in the same area. See SI joint pain
- Medial branch block. A doctor uses X-ray guidance to place a little local anesthetic next to the small nerves that supply the painful joints. If your usual pain drops a lot for a few hours, the facet joints are the likely source
- Often done twice. A single block gives a false positive in roughly 3 to 4 people in 10, so many doctors repeat it on a different day before going further
Facet wear on a scan is almost universal with age. A numbing test, not a picture, tells you if those joints are what hurts.
What helps first
- Keep moving. Walking and normal activity help more than rest. Stiff joints usually ease with movement
- A regular exercise program. Strength work for your trunk, hips and legs, plus movement in the directions that feel good. Pilates, swimming and gym work all count. Choose what you’ll keep doing
- Physio. A physio can find the moves that ease your pain, build your tolerance to the ones that flare it, and give you a plan for bad days
- Break up long spells of standing still or sitting. Short walks or a change of position every 20 to 30 minutes help
- Heat for stiffness, especially in the morning
- Pain relief for flare-ups: anti-inflammatory painkillers help some people. Check with your pharmacist that they’re safe for you
- Give it time. Improvement with exercise builds over weeks to months, not days
Facet injections vs radiofrequency ablation
If pain stays bad after a proper try of exercise, two needle treatments are on offer. They’re NOT the same thing.
- Facet joint injection. Steroid, often with local anesthetic, is injected into the joint itself. Some people get a few weeks or months of relief, but the evidence that they beat a dummy injection is weak. UK guidelines no longer recommend them for low back pain, though they’re still used in many places
- Radiofrequency ablation. A needle heats the medial branch nerves so they stop sending pain signals from the joint. It’s only offered after medial branch blocks have given clear relief. Relief often lasts about 6 to 12 months, sometimes longer. See radiofrequency ablation
- The nerves grow back. When they do, pain can return, and the treatment can be repeated
- Honest scales. Trials disagree on how much ablation adds on top of a good exercise program. Some people get strong relief, some very little. Use any pain-free window to build strength, so you’re in better shape if the pain comes back
- Surgery is rarely the answer for facet pain alone
Go to the emergency department now if
These aren’t facet joint problems. They can be signs of cauda equina syndrome, where the bundle of nerves at the bottom of the spine is badly squashed. It’s rare, but it needs hospital assessment the same day. Don’t wait to see if it settles.
- New trouble peeing, not being able to pee, or leaking pee or poo without knowing
- Numbness around your genitals, buttocks or inner thighs, the area that would touch a saddle
- Weakness or numbness in BOTH legs, or pain down both legs
- New problems getting an erection, or loss of feeling during sex
Get it checked if
- A leg or arm is getting weaker, or your foot catches when you walk
- Your legs ache and feel heavy when you walk and ease when you sit or bend forward. That points to narrowing around the nerves. See spinal stenosis
- The pain started after a fall or accident, especially if you’re older or have thin bones
- You have a fever, weight loss you can’t explain, or a history of cancer
- The pain is constant and worse at night, whatever position you’re in
- There’s no improvement after 6 to 8 weeks of regular exercise
Move it and strengthen it first, test it before you treat it, and use any needle as a window for exercise, not a cure.