Facet Joint Pain

A condition guide by Mr Mohammed Madi, Consultant Orthopaedic & Spinal Surgeon.

The facet joints are the small joints at the back of the spine that guide its movement. Like any joint, they can become worn and painful, and they are a recognised source of back and neck pain. This page explains what facet joint pain is, how it is identified, and how it is treated — including where injections and radiofrequency treatment do and do not help.

Running down the back of the spine, at every level, is a pair of small joints called the facet joints (also known as the zygapophyseal joints). They link each vertebra to the one above and below, and they guide and limit how the spine bends and twists. Like the joints in the hands, hips or knees, facet joints have cartilage surfaces and a lining, and over time they can develop wear-and-tear arthritis. When this becomes a source of pain, it is called facet joint pain, which can occur in the lower back (lumbar) or the neck (cervical).

In plain terms: the facet joints are like the hinges at the back of each segment of the spine, and — like any hinge that has worn over the years — they can become stiff and sore.

Each facet joint is supplied by tiny nerve branches called the medial branches. These nerves carry pain signals from the joint, and they are important because they can be targeted both to test whether a joint is the source of pain (with a numbing injection) and, in selected cases, to treat it. Each joint is supplied by more than one medial branch, which is why these procedures are planned carefully.

The usual cause is age-related wear (osteoarthritis) of the joints, which often goes hand in hand with disc degeneration at the same levels — as discs lose height, more load passes through the facet joints behind them. Facet pain becomes more common with age. It can also follow an injury, and is associated with the same general factors that affect other joints, such as previous heavy use and being significantly overweight. Importantly, facet arthritis is extremely common on scans of people who have no pain at all, so its presence on imaging does not by itself prove it is the cause of someone's symptoms.

Facet joint pain is typically felt as a deep, aching pain in the back or neck itself (axial pain) rather than pain shooting down a limb. Characteristic features include:

Pain that is often worse when leaning backwards (extension) or twisting, and after periods of standing or walking.

Stiffness, particularly first thing in the morning or after rest, that eases with gentle movement.

Localised tenderness over the affected joints.

Pain that may spread into the buttock and back of the thigh (from lumbar joints) or into the shoulder, shoulder blade and back of the head (from cervical joints) — but which does not usually travel below the knee or into the hand, as that pattern suggests a trapped nerve instead.

These features overlap with other causes of back and neck pain, which is why facet joint pain cannot be diagnosed on symptoms alone.

Diagnosis begins with a clinical assessment of the pattern of pain and a focused examination. Imaging (X-ray, CT or MRI) can show facet joint arthritis, but because such changes are so common in people without pain, scans cannot reliably confirm that the joints are the source of symptoms.

The most specific test is a diagnostic medial branch block — a small injection of local anaesthetic placed precisely at the nerves supplying a suspected joint. If the pain is substantially relieved for the expected duration of the anaesthetic, it suggests those joints are contributing to the pain. These blocks are useful but imperfect: they carry a meaningful false-positive rate, so results are interpreted carefully, and in some cases a confirmatory second block is used before any longer-lasting treatment is considered.

Like arthritis elsewhere, facet joint pain tends to fluctuate, with better and worse spells rather than relentless progression. Many people manage well with simple measures and periods of flare-up settle with time. It is a cause of discomfort and stiffness rather than a dangerous condition, and it does not threaten the nerves in the way that some other spinal problems can.

As with most back and neck pain, the first-line treatment is non-surgical and aims to keep the spine mobile and strong:

Staying active and avoiding prolonged rest.

Physiotherapy and exercise to build the supporting muscles, improve posture and movement, and reduce load on the joints.

Weight management, which reduces the load passing through the joints.

Simple pain relief, such as anti-inflammatory medicines used sensibly, during flare-ups.

Where pain is persistent and significantly limiting despite these measures, and where assessment points to the facet joints, targeted procedures may be considered:

Medial branch blocks, primarily as a diagnostic test (and sometimes giving temporary relief).

Radiofrequency denervation (medial branch neurotomy) — a procedure that uses heat to interrupt the small nerves carrying pain from a confirmed facet joint. In carefully selected people who have responded well to diagnostic blocks, it can provide several months of meaningful pain relief, and it can be repeated if the benefit wears off as the nerves recover. The evidence supports it as a worthwhile option for the right patients, while emphasising that careful selection is the key to success.

Facet joint pain on its own is not usually treated with surgery, and spinal fusion is not recommended simply for facet-related back pain. Surgery is reserved for specific structural problems — for example significant instability or nerve compression — rather than for joint pain itself.

The outlook is reassuring. Facet joint pain is a manageable, non-dangerous condition. Most people do well with exercise, activity and sensible self-management, with injections and radiofrequency treatment available as targeted options for those whose pain is persistent and clearly arising from the joints. Expectations are best set realistically: these treatments manage pain and improve function, rather than reversing the underlying wear.

"My scan shows facet arthritis, so that must be my pain." Facet wear is very common in pain-free people; imaging alone cannot confirm it as the source.

"A facet injection will cure it." Injections mainly help to identify the source and give temporary relief; they are not a permanent cure.

"Radiofrequency treatment is permanent." The nerves recover over time, so relief is typically for some months and the procedure can be repeated.

"I need a fusion for facet pain." Fusion is not a routine treatment for facet joint pain.

"I should rest until it settles." Staying active and building strength is more effective than rest.

The facet joints are small joints at the back of the spine that can develop wear-and-tear arthritis and become a source of back or neck pain — typically a deep ache, worse with leaning back or twisting, that does not shoot down a limb. Because facet arthritis is common on scans of pain-free people, the diagnosis relies on the clinical pattern and, where needed, diagnostic nerve blocks rather than imaging alone. Most people do well with activity, exercise and simple measures, and for carefully selected people, radiofrequency treatment can give months of relief. Surgery is not a routine treatment for facet pain.

This page is for general education and does not replace advice from your own clinical team. Seek prompt review if you develop leg or arm weakness, numbness, pain travelling below the knee or into the hand, or any disturbance of bladder or bowel control, as these suggest a different problem.

• —Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591–614.
• —Manchikanti L, Kaye AD, Soin A, et al. Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain. Pain Physician. 2020;23(3S):S1–S127.
• —van Kleef M, Vanelderen P, Cohen SP, et al. Pain originating from the lumbar facet joints. Pain Practice. 2010;10(5):459–469.
• —Maas ET, Ostelo RWJG, Niemisto L, et al. Radiofrequency denervation for chronic low back pain. Cochrane Database of Systematic Reviews. 2015;(10):CD008572.

This information is for general patient education and is not a substitute for an individual consultation. Always seek personalised advice from a qualified spinal specialist.