Facet joint pain

What are the reasons for facet joint pain?

Lumbar (lower back) facet joints account for 15–45% of lower back pain sources. Here are some of the causes:

• Cartilage wearing down (degenerative change) in the facet joint is a common cause of pain

• Injury

• Repetitive movements loading these joints

• Poor posture

• Obesity

• Spine conditions that affect the curves of the spine, disc and bone health, and alignment

​

Symptoms of facet joint pain

• Localized pain (commonly dull ache)

• Stiffness

• Worse after rest (referred pain)

• Sciatica (sharp shooting pain down the buttock up to the knee and radiating pain)

• Tender to touch

• Grinding or grating feeling in the joints (if arthritic changes)

​

When should I seek medical help?

There are circumstances when back pain might be caused or accompanied by serious issues. If such symptoms are present it is best to seek immediate medical attention to avoid further complications.

Although these are rare to encounter, it is always good to make sure you have no worrying symptoms.

• Your pain is caused by a major accident such as a traffic collision, or a fall

• You have osteoporosis or there is a visible change in shape/deformity in your back

• Weakness, numbness, or tingling in one or both lower limbs

• Loss of control of your bladder or bowels

• The pain is disturbing your sleep

• Previous history of cancer

• If you have a fever, chills, or unexplained weight loss

​

Diagnosis

The symptoms of facet joint pain can resemble other spine issues therefore it is often difficult to diagnose. Your doctor will take your medical history, perform a physical evaluation and range of motion, and special tests to rule out other causes and confirm the diagnosis. They might also palpate the painful area to confirm the tissues and structures giving rise to the pain.

Imaging can be helpful in diagnosis and ruling out other causes and may include:

• X-ray

• CT

• MRI

Imaging is often ordered when the first line of treatment such as exercises did not produce the wanted results.

A facet joint injection can also be performed to confirm the diagnosis. The joint is injected with corticosteroids and analgesics guided by X-ray fluoroscopy. If your pain decreases by more than 75% the facet joint is confirmed as a source of a problem.

​

Treatment

First-line therapy can involve a combination of:

• Physical therapy, osteopathy (exercises, education about pain, improving spinal curves, spinal manipulations)

• Anti-inflammatory medication

• Weight loss

• Muscle relaxers

• Massage

If the treatments above do not provide the needed results, the following interventions can be considered

• Facet joint injections (with local anesthetic and steroids)

• Nerve block injection (heat is used to temporarily destroy part of sensory nerve, which causes reduction of pain sensation)

• Chronic pain treatment

​​

Recovery and Prevention of facet joint pain

It is important to note that using medications or injections does not normally remove the underlying problem, but rather helps to manage symptoms.

Appropriate and regular exercises that help mobilize, stretch and strengthen the area, as well as cardio exercises helping improve blood flow and healing can slow down the wear and tear process and prevent any issues involving facet joints.