Facet joint syndrome: a common and frequently missed cause of back pain
Think facet joint pain may be causing your back pain?
The myBackPain assessment identifies the facet joint pattern from your specific answers — and distinguishes it from disc-related and other causes. Results in minutes.
What are the facet joints?
The facet joints — also called zygapophyseal joints — are paired joints at the back of each vertebral segment that guide and limit spinal movement. Each level of the spine has two facet joints, one on each side. They work with the disc at that level to allow controlled movement while preventing excessive motion.
Image: Wikimedia Commons / CC BY-SA 4.0
Facet joints are a source of back pain in up to 40% of people with chronic lower back pain, yet they are frequently attributed to more general “mechanical back pain” without specific identification of the facet joint as the primary structure involved. This matters because the most effective treatments for facet joint pain are different from those for disc-related pain, and a generic approach often misses the target.
What does facet joint syndrome feel like?
The facet joint pattern has a characteristic presentation that distinguishes it from disc-related pain:
Typically worse with
- Leaning backwards (extension)
- Twisting and rotation
- Prolonged standing
- First thing in the morning
- Walking downhill or downstairs
Typically better with
- Leaning forward (flexion)
- Sitting down
- Gentle movement after initial stiffness
- Lying in a comfortable position
- Localised lower or mid back pain, often on one or both sides
- Pain that refers into the buttock and posterior thigh — but usually not below the knee
- Stiffness after prolonged static postures — sitting for a long time, driving, standing
- No neurological symptoms such as numbness, tingling, or leg weakness
- Pain that may be sharp on certain movements and then ease off
The most reliable differentiator is the extension pattern. Facet joint pain is typically worse with backward bending and better with forward bending. Disc-related pain is typically the reverse — worse with forward bending and sitting, often better with backward bending. This single distinction has significant implications for which treatment approach is most likely to help.
What causes facet joint syndrome?
- Age-related wear on the cartilage lining the facet joints — facet osteoarthritis is very common over 50
- Degenerative disc disease — as disc height reduces, the facet joints take more load, accelerating degeneration
- Repeated extension loading — occupations or sports involving sustained or repeated backward bending
- Acute injury — a sudden compressive or rotational force can acutely injure the facet capsule
- Poor posture over time — sustained lumbar extension postures load the posterior structures including the facets
- Previous spinal surgery at adjacent levels — altered load distribution can accelerate facet degeneration
How is it identified?
Facet joint syndrome is primarily a clinical diagnosis — identified from the pattern of symptoms and examination findings rather than imaging alone. MRI and X-ray can show facet joint changes, but these are extremely common on imaging in adults over 40 and do not always correlate with symptoms. The clinical pattern of extension-dominant pain with referred buttock symptoms and no neurological features is the most reliable indicator.
A definitive diagnosis can be made by a fluoroscopically guided facet joint injection or medial branch block, which both confirms the facet as the pain source and provides treatment.
The assessment identifies the facet joint pattern from your answers — specifically the extension aggravation, referred buttock pain pattern, and absence of below-knee neurological symptoms. This distinction from disc-related pain guides the management recommendations in your report.
What helps?
Manual therapy
Facet joint mobilisation and manipulation is highly effective for facet-mediated pain. Both gentle oscillatory mobilisation and, where appropriate, higher-velocity techniques address facet joint dysfunction directly. This is one of the most treatment-responsive causes of back pain.
Exercise
Core stability and flexion-biased exercises reduce load on the posterior structures. Avoiding sustained extension positions. Swimming and walking are typically well tolerated. Specific exercise prescription from a practitioner produces better outcomes than generic advice.
Facet joint injection
An injection of local anaesthetic and steroid directly into the facet joint or the nerve supplying it. Both diagnostic — it confirms the facet as the pain source — and therapeutic. Can provide significant medium-term pain relief.
Radiofrequency ablation
For chronic facet pain confirmed by diagnostic nerve blocks — the nerves supplying the facet joints are ablated using heat to provide longer-term pain relief. Typically lasts 6–18 months and can be repeated.
Sustained extension postures — prolonged standing with an arched lower back, sleeping prone. Backward bending exercises in the acute phase. These load the facet joints directly and will aggravate symptoms.
PDF — a printable summary to share with your GP or practitioner
Not sure if facet joint syndrome is causing your back pain?
The myBackPain assessment identifies the facet joint pattern from your specific answers — and distinguishes it from disc-related and other causes of back pain.