Spine and Facet Joint Pain FAQs: Causes, Diagnosis, and Treatment

Facet joints are small joints located at each level of the spine that allow your back to bend and twist. Like other joints, they have cartilage and a joint capsule. When the cartilage wears down from aging, injury, or arthritis, the bones can rub together and cause pain. Facet joint pain is a common cause of chronic back and neck pain.

The most common cause is osteoarthritis from normal wear and tear over time. Other causes include injury or trauma, poor posture, repetitive stress, excess body weight, and degenerative disc disease. As discs lose height, more stress is placed on the facet joints, accelerating their breakdown.

Diagnosis starts with a physical exam where your doctor checks for tenderness over the facet joints and pain with specific movements. Imaging like X-rays and MRI can show joint degeneration. The most definitive test is a diagnostic facet block, where numbing medication is injected into the joint. If pain is temporarily relieved, the facet joint is confirmed as the source.

Treatment options range from conservative to interventional. Physical therapy, core strengthening, and posture correction are first-line treatments. Medications include NSAIDs and muscle relaxants. Facet joint injections with corticosteroids reduce inflammation. Nerve blocks and radiofrequency ablation provide longer-lasting relief. Surgery is rarely needed.

A nerve block involves injecting anesthetic and sometimes steroid medication near the nerves that carry pain signals from the facet joints. This interrupts pain signals and reduces inflammation. Medial branch blocks target the specific nerves serving the facet joints. They can provide weeks to months of relief.

Physical therapy strengthens the core muscles that support your spine, reducing the load on facet joints. It improves flexibility, corrects posture, and teaches body mechanics to prevent further damage. Your therapist will create an individualized program that may include stretching, strengthening, manual therapy, and pain-relief techniques.

Surgery is rarely needed for facet joint pain. It is considered only when all non-surgical treatments have failed after 6-12 months, pain is severe and disabling, and imaging confirms the facet joints as the pain source. Procedures may include facet joint fusion or decompression. Most patients improve with non-surgical approaches.

For lower back facet pain, sleeping on your side with a pillow between your knees reduces spinal stress. Sleeping on your back with a pillow under your knees maintains natural spine curves. Avoid sleeping on your stomach, which increases lower back strain. A supportive mattress and proper pillow height also make a significant difference.

Low-impact exercises are best. Walking, swimming, and stationary cycling are gentle on the spine. Core strengthening exercises like planks and bridges support the spine. Gentle stretching improves flexibility. Avoid exercises that involve heavy lifting, twisting, or extreme back extension, which can aggravate facet joints.

While you cannot prevent all age-related joint changes, you can reduce your risk. Maintain a healthy weight to reduce spinal stress. Practice good posture while sitting and standing. Stay active with regular low-impact exercise. Strengthen your core muscles. Lift with proper form using your legs, not your back. Avoid prolonged sitting without breaks.