Facet Joint Syndrome

Facet joint syndrome is pain coming from the small paired joints at the back of your spine. It is one of the most common sources of chronic neck and lower back pain in adults and almost always improves with non-surgical care.

What's happening in your spine

Behind every pair of vertebrae sit two small facet joints. They guide motion and stop your spine from twisting too far. Each joint is lined with cartilage and wrapped in a tiny capsule, and each one is supplied by a small medial branch nerve. With age, injury, or arthritis the cartilage wears down and the capsule becomes inflamed, which the nerves report as pain.

Common symptoms

• Deep, achy pain in the neck or lower back
• Pain that worsens with standing, twisting, or leaning backward
• Pain that eases when you sit or lean forward
• Morning stiffness that loosens with movement
• Referred pain into the shoulders, buttock, or upper thigh (rarely below the knee)

Causes & risk factors

The most common cause is wear-and-tear arthritis of the facet joints. Risk increases with age, prior spine injury, repetitive heavy lifting or twisting, scoliosis or other spine asymmetry, and earlier disc degeneration that places more load on the facets.

How it's diagnosed

Diagnosis is based on a focused history and exam. Pain that is reproduced by extending and rotating the spine is a classic clue. X-rays, CT, or MRI can show facet arthritis, and a diagnostic medial branch block — a small targeted injection of numbing medicine — is often the most reliable way to confirm the facet joints as the pain source.

Treatment options

The great majority of patients improve without surgery.

• Activity modification and short courses of anti-inflammatory medication
• Physical therapy focused on core stability, hip mobility, and posture
• Targeted manual therapy and home stretching
• Image-guided facet joint injections to calm a painful flare
• Radiofrequency ablation of the medial branch nerves for confirmed facet pain that keeps returning

Surgery is rarely needed purely for facet pain. When facet arthritis is part of a larger problem such as spinal stenosis or spondylolisthesis, a decompression or fusion may be considered, but only after non-surgical care has been fully tried.

When to see a specialist

See a spine specialist if neck or back pain lasts more than 6 weeks, if it keeps coming back, or if it limits work, sleep, or daily activities. Sudden new weakness, numbness, or loss of bowel or bladder control needs emergency evaluation.