What are the facet joints?
Small paired joints at the back of each vertebra that let the spine bend and twist while limiting too much motion.
Every level of the spine has two facet joints, one on each side. Like other joints, they're lined with cartilage. As that cartilage wears, bone can rub on bone, causing pain, stiffness and inflammation. That wear is called facet arthropathy, or facet arthritis. The pain it produces is called facet syndrome (Cleveland Clinic).
Risk factors include age (especially over 45), past back injury or surgery, physical work that strains the back, extra body weight, and disc degeneration, which shifts more load onto the facets (Cleveland Clinic).
Facet pain vs. disc pain: how do they compare?
Facet pain tends to stay in the back and flare with leaning back; disc pain more often flares with sitting and can travel down a leg.
| Facet joint pain | Disc-related pain | |
|---|---|---|
| Where it's felt | Back or neck, near the spine; may refer to buttock, hip or thigh | Back, often with pain below the knee or into the arm |
| Numbness or tingling | Uncommon | Common when a nerve is irritated |
| Often worse with | Leaning back, twisting, standing long, mornings | Sitting, bending forward, coughing |
| Imaging | Arthritis is common even without pain | Bulges and herniations are common even without pain |
| Decompression | Usually not a first choice | May be considered after an exam |
Sources: StatPearls, Cleveland Clinic, Mayo Clinic. Many people have both, especially after 50.
How is facet syndrome diagnosed?
Mostly from your history and exam. Imaging helps rule other things out, and nerve blocks can confirm it.
Facet arthritis shows up on X-ray, CT and MRI, but it's common in people without pain too, and how bad it looks doesn't match how much it hurts (StatPearls). The most reliable test is a diagnostic medial branch block: numbing the small nerves to the joint and seeing whether the pain goes away.
How is facet joint pain treated?
Exercise and physical therapy, pain relievers, and activity changes first; injections or radiofrequency ablation if those don't help.
- Physical therapy to strengthen core and back muscles (Cleveland Clinic).
- Medication such as NSAIDs or acetaminophen, if safe for you.
- Activity changes: fewer repetitive twisting movements; low-impact exercise like walking or swimming.
- Facet injections and radiofrequency ablation, done by pain-management physicians, for pain that persists.
Chiropractic care is one of the non-drug options used for low back pain in general (MedlinePlus); ask whether it's appropriate for you.
Where does spinal decompression fit?
Honestly, not usually for pure facet pain. It's aimed at discs.
Decompression is designed to ease pressure on discs and nerve roots. If your exam points mainly to the facet joints, Dr. Gordon Stapel, DC will say so and talk about other options, including a referral when that's the better path. If a disc problem is also part of the picture, he'll explain whether decompression is reasonable to try. Research on decompression is limited and results vary. Call (801) 491-8688 with questions.
Facet joint FAQs
What is facet syndrome?
Is facet pain worse bending forward or backward?
Does facet joint pain go down the leg?
Can an MRI diagnose facet syndrome?
Is spinal decompression used for facet syndrome?
Not sure if it is facet or disc pain?
Prefer to talk now? Call (801) 491-8688. Or send this short form and the office will call you back during business hours, usually within 2 business days.
Sources
This website is operated for Stapel Family Chiropractic (Springville Disc Center) in Springville, Utah. Care is provided by Dr. Gordon Stapel, DC, a licensed chiropractic physician. About this site.