Facet Joint Pain

What is Facet Joint Pain?

Each vertebra connects to the ones above and below it through two small joints at the back of the spine called facet joints (also known as zygapophyseal joints). These joints guide and limit spinal movement, but like any joint in the body, they can develop arthritis, inflammation, or injury over time.

Facet joint pain is responsible for up to 45% of chronic lower back pain cases, making it one of the most common and most underdiagnosed spinal pain sources. In older adults it is often the primary driver of back pain, frequently co-existing with disc changes on the same scan. Standard imaging (X-ray, CT, MRI) is unreliable for diagnosing it: the gold standard is a diagnostic facet joint block or medial branch block, where a small injection of local anaesthetic briefly numbs the joint and confirms whether it is the pain source.

The condition develops gradually through wear and tear, poor posture, repetitive loading, or following a whiplash-type injury. The joints become inflamed, stiff, and painful, particularly with extension and rotation movements.

Symptoms

• Deep, aching lower back or neck pain without a clear radiating pattern
• Stiffness in the morning that eases after moving around
• Pain with arching backward, twisting, or standing for long periods
• Tenderness directly over the spine at the affected level
• Pain that often improves with sitting or bending slightly forward
• Referred pain into the buttocks, thighs, or shoulders (but rarely below the knee)

How We Treat It

Diagnosing facet joint pain accurately comes first. We use medial branch blocks, which numb the small nerves that carry pain from the facet joints, to confirm the diagnosis and provide immediate relief. If the block produces significant pain reduction, it also confirms that the joints are genuinely the source: this matters because it directs treatment confidently.

For longer-term relief, radiofrequency ablation of the medial branch nerves can interrupt pain signalling from the affected joints for 12 to 18 months or more. Intra-articular steroid injections reduce inflammation within the joint itself and are useful for acute flares. We combine these with targeted physical therapy where appropriate, to address the postural and loading factors that stress these joints and prevent the cycle from repeating.