Facet joint pain comes from facet joints that are injured or worn down. These joints keep the spine steady and let it bend. X-rays, MRI and diagnostic blocks confirm it. Physical therapy and medicine come first. Then facet joint injections and radiofrequency ablation (RF) give long-term relief for arthritis of the low back facet joints.
Facet joints keep your spine steady and let it bend. But when they are hurt or worn down, they can cause intense pain. In this post, we look at how facet joints work and how damage or wear causes pain. We cover how doctors find the problem, using X-rays, MRI scans and diagnostic blocks. You will learn about conservative (non-surgical) care, like physical therapy and the drugs most often prescribed for facet pain. Then we cover stronger options, including facet joint injections and radiofrequency ablation (RF). These have shown good results for long-term relief in people with arthritis of the low back facet joints. You will also learn about two features of these joints, their angle and whether the two sides match. Both matter when a doctor looks for the cause of low back pain.
Table of Contents
- What are facet joints, and why do they cause back pain?
- Anatomy and Function of Facet Joints
- What Causes Facet Joint Degeneration?
- How is facet joint pain diagnosed?
- Imaging Techniques Used for Diagnosis (X-rays & MRI)
- Diagnostic Blockage Procedure
- Can facet joint pain be treated without surgery?
- Physical Therapy Approaches
- Medications Commonly Prescribed
- When do you need facet injections or radiofrequency ablation?
- Facet Injections: Procedure and Benefits
- How does radiofrequency ablation work, and how long does it last?
- The Importance of Structural Parameters in Facet Joints
- FAQs in Relation to Facet
- What are facet joints and their purpose?
- What is the best treatment for facet joint pain?
- What activities aggravate facet joints?
- Why is facet joint pain so bad?
- Conclusion
What are facet joints, and why do they cause back pain?
Facet joints, also known as lumbar zygapophysial joints, are the reason your lower back hurts so much.
Anatomy and Function of Facet Joints
Facet joints are small synovial (fluid-filled) joints. They let your spine move and bend without friction.
What Causes Facet Joint Degeneration?
- Osteoarthritis: Normal wear and tear can lead to osteoarthritis. That causes inflammation and stiffness around the joint.
- Injury: Car crashes and sports injuries can damage facets and cause pain in one spot.
- Poor Posture: Poor posture over time puts too much strain on parts of your spine. That makes existing problems worse.
If you want relief from long-term low back pain, you need to know how facet joints work and what wears them down.
How is facet joint pain diagnosed?
Low back pain can last and wear you down. Finding its source is the key to fixing it.
Imaging Techniques Used for Diagnosis (X-rays & MRI)
Doctors use X-rays and MRI to spot problems or wear in the facet joints. X-rays [2] give a clear view of the bones of your spine. An MRI shows more detail of the soft tissue around these joints.
Diagnostic Blockage Procedure
A diagnostic block shows whether facet joint pain is causing your symptoms. The doctor injects numbing medicine into the joint that seems to hurt, using live X-ray (fluoroscopy) to guide the needle. If your pain drops significantly after this shot, that joint is the cause. Doctors may also suggest drugs like anti-inflammatories or muscle relaxers while they test. These can ease some symptoms for a while during testing. What these tests show is key to picking the best treatment for your facet pain. Conservative care like physical therapy may be enough. But if your pain lasts or gets worse, you may need stronger treatment.
Can facet joint pain be treated without surgery?
Surgery is not the only option for facet joint pain. Physical therapy can work instead.
Physical Therapy Approaches
Stretching helps you move more freely. Strength exercises give your spine better support. Low-impact exercise keeps you fit. Heat or cold packs can give short-term relief.
Medications Commonly Prescribed
NSAIDs such as ibuprofen may reduce inflammation. If conservative care does not work, stronger pain relievers or muscle relaxers may be prescribed. Physical therapy plus the right medicine can bring relief without surgery. But if conservative care fails, you may need stronger options.
When do you need facet injections or radiofrequency ablation?
When standard care fails, targeted shots or radiofrequency ablation may be needed for pain that will not quit. 
Facet Injections: Procedure and Benefits
Facet joint injections reduce inflammation and give short-term pain relief. Some patients improve significantly after just one shot.
How does radiofrequency ablation work, and how long does it last?
RF blocks the nerves that carry pain signals. In some patients it gives significant relief for up to two years.[3]
- Studies show RF cuts the need for pain medicine.
- RF may miss the source of the pain. Sometimes it might need to be done more than once.
The Importance of Structural Parameters in Facet Joints
The angle of the low back facet joints, and whether the two sides match, helps show their role in long-term low back pain. Joints set at an odd angle can put more stress on the spine. That raises the risk of low back pain and other spine problems. When the left and right joint angles do not match, one side of the disc can take too much pressure. Over time, that leads to long-term low back pain. Research shows that people with significant mismatch may have more disc wear in the low back, because the load across the spine is uneven. When they understand these features, healthcare professionals can better find and treat low back pain caused by facet joint problems. This knowledge also opens the door to research on better treatments for these spine problems.
FAQs in Relation to Facet
What are facet joints and their purpose?
The purpose of facet joints, also known as zygapophyseal joints, is to keep the spine steady and let it bend.
What is the best treatment for facet joint pain?
Common treatments for facet joint pain include physical therapy, medicine, facet injections, and radiofrequency ablation.
What activities aggravate facet joints?
Heavy lifting, long sitting with poor posture, high-impact sports, golf or tennis can flare facet joints.
Why is facet joint pain so bad?
Facet joint pain can be severe because inflammation and worn cartilage between the facets irritate nerves and add friction when you move.
Is heat good for facet joint pain?
Heat and cold packs both help, but the relief is short-lived. They work best as one part of a physical therapy plan. That plan also includes stretching to help you move, strength work to support the spine and low-impact exercise. Anti-inflammatory medicine such as ibuprofen may also reduce inflammation while the plan does its work.
Is walking good for lumbar facet joint pain?
Low-impact exercise, such as walking, is part of physical therapy for facet joint pain. It keeps you fit without heavy strain on the spine. Pair it with stretching and strength work. What tends to flare facet joints is heavy lifting, long sitting with poor posture, and high-impact sports.
Do facet joint injections work?
Facet joint injections reduce inflammation and give short-term pain relief. Some patients improve significantly after just one shot. A diagnostic block with numbing medicine, placed under X-ray guidance, also shows whether a facet joint is the true source of your pain. If the relief does not last, radiofrequency ablation is the next step for longer control.
Will facet joint pain ever go away?
Facet joint pain comes from joints that are worn down or hurt, so the goal is long-term control. Physical therapy and medicine come first. When they fail, radiofrequency ablation blocks the nerves that carry the pain signal. In some patients it can give significant relief for up to two years. It may need to be repeated, and it cuts the need for pain medicine.
Conclusion
Facet joints are a big deal in spine pain, so know how they are built and how they work. Wear or damage in them can lead to long-term back pain. Doctors find it with X-rays and MRI. Don’t fret, though. Treatment for facet joint pain includes physical therapy, medicine, injections, and radiofrequency ablation (RF). The angle of the joints, and whether the two sides match, also affect low back pain.
Reference
[1]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799189/ [2]. https://www.spine-health.com/treatment/diagnostic-tests/getting-accurate-back-pain-diagnosis [3]. https://www.mayoclinic.org/tests-procedures/radiofrequency-neurotomy/about/pac-20394931
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Dr. Gurpreet Singh Padda, MD, MBA, MHP
