Facet Joint Disorders and Pain: What to Know

The facet joints of the spine are located at the back part of the spine. They exist on every vertebra (small spine bones), and each vertebra has two sets. The facets prevent excessive motion when the spine turns and bends. Facet disorders and pain are often caused by natural wear and tear on facets over time. 

Facet joint disorders frequently affect the lower back (lumbar spine) and neck (cervical spine), but the mid-back (thoracic spine) can sometimes be involved. 

This article covers the function of the facet joints, what facet joint pain feels like, additional symptoms, causes, and more.

Facet Joint

What Does a Facet Joint Do?

The facet joints are the connections between the vertebrae (bones of the spine). The function of each facet is to guide and limit movement in each vertebra. 

The facet joints also provide flexibility and stability to the spinal column. They help the spine to bend and twist and keep the back from extending too far forward or twisting more than normal.

Where Are Facet Joints Located?

The facet joints are located along the entire length of the spine on the back of the spine. You have two facet joints between each vertebra—one on each side. Each facet joint has two bony knobs that connect two vertebrae. 

The facet joints are located along the entire length of the spine—from the upper cervical spine to the thoracic spine and to the lower lumbar spine. Their location helps to support the body’s weight and allows for various spine movements. 

What Does Facet Joint Pain Feel Like?

Facet joint pain is often described as a dull ache in the back. Depending on the affected facet joints and their location on the spinal column, you might experience additional symptoms, including a sharp shooting pain that radiates from the lower back to the buttock, thigh, calf, and foot.

Facet joint pain typically affects one side or both sides of the back. Any facet joint can produce pain affecting the back, buttocks, hips, and groin. Pain can sometimes radiate into one or both buttocks, the groin, and thighs. Sometimes, the pain mimics pain that is caused by a herniated disc or nerve root compression.

Some signs and symptoms of facet diseases are similar to those of lower back and neck disorders, including disc disease. These conditions might present together and cause overlapping symptoms, making diagnosis challenging. 

Various conditions can affect the facet joints, including:

Symptoms of Facet Joint Problems

Most people with facet joint syndrome experience pain in the lower back due to the stress the back takes for the entire body. Symptoms vary depending on the number of facet joints affected, the location within the spine, the severity of damage, and whether nerve roots are affected.

General symptoms of facet joint problems may include:

  • A dull ache in the back 
  • Muscle weakness 
  • Tenderness over the affected facet joint area
  • Pain that is worse in the morning and after periods of inactivity or too much bending or rotation of the spine
  • Stiffness if an arthritic condition causes facet joint pain
  • A feeling of grinding or grating with spine movement called crepitus

If a facet joint disorder affects the lower back, you might also experience the following:

  • Referred pain to the buttocks, hips, and legs
  • Radiating pain if there is nerve compression at the facet joint
  • Sciatica pain that is sharp and shooting, affecting one side of the body, radiating into the back, buttocks, hips, and legs, and that worsens with sitting or standing

If facet joint syndrome affects the neck, you may experience symptoms specific to the cervical spine. Such symptoms include:

  • Neck pain
  • Trouble moving the neck and head
  • Headache
  • Pain that radiates into the upper part of the neck, shoulders, and upper and middle back. 

While rare, facet joint syndrome might affect the thoracic spine. Symptoms include:

  • Mid-back or rib cage pain
  • Muscle and joint pain in the shoulder blades and neck
  • Stiffness in the morning or after sitting for a long time
  • Reduced range of motion, especially when trying to turn the neck or body to the side
  • Pain with movement
  • Pain when moving the hands
  • Mid-back discomfort when sitting for too long 

If one facet joint on one side is involved, you might feel pain on just one side. Pain on both sides is called bilateral facet joint pain.

What Causes Facet Joint Syndrome?

Facet joint syndrome is often caused by degenerative wear and tear on the bones associated with aging. Facet joint syndrome arising from arthritic changes is a common cause of lower back pain. It affects 15% to 45% of people with chronic back pain.

Degenerative conditions that might affect the facet joints include spinal OA and disc degeneration, which can cause the following symptoms:

  • Spinal OA can damage the facet’s cartilage, leading to inflammation, stiffness, and pain from bone-on-bone grinding with joint movement.
  • Degeneration of the intervertebral discs (vertebra cushions) can lead to height reductions that bring joint surfaces closer, affecting normal movement and increasing stress on facet joints.

Additional causes of facet joint syndrome include:

  • Spinal fractures 
  • Poor posture
  • A sedentary lifestyle 
  • Being overweight 
  • Repetitive stress on the joints from bending or twisting 
  • Torn ligaments 
  • Sudden, forceful stretching movements or overexertion of the facets
  • Trauma from an accident, sports injury, or a fall
  • Inflammatory arthritis conditions that can cause spinal inflammation, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis (RA)

Facet Joint Hypertrophy, Arthritis, and Cysts

Facet joint hypertrophy means there are degenerative changes and enlargement of the facet joints of the spine. Aging, arthritic changes, and facet degeneration are often to blame. 

Widespread (systemic) arthritic conditions—including AS, PsA, and RA—can cause inflammation that leads to facet arthropathy. Facet arthropathy is known for causing advanced deterioration of the lumbar facet joints. Symptoms might mimic those of lumbar herniated discs and sciatica.

Other causes might include a facet joint injury (i.e., automobile accident or sports injury) or a synovial cyst. A synovial cyst is a fluid-filled lump that develops along the spine. These cysts are common and do not always cause symptoms.

However, depending on their size and location, they may cause symptoms similar to spinal stenosis. Such symptoms include backache, pinched nerve pain, numbness, difficulty moving, and bladder and bowel function changes. 

How a Facet Joint Disorder Can Cause Back Pain

The facet joints take on significant stress from the upper body. These joints will experience wear and tear over time and become weak. They might also experience trauma leading to back pain. 

Facet joint pain can also cause back pain with inflammation and degeneration of the facet joints. Inflammatory disorders and degenerative changes can lead to widespread, achy back pain. 

Back pain may come and go. The pain might worsen with certain activities and movements, including leaning back or to the side of the affected facet joint area.

Facet joint pain is often localized to the neck and back, with some radiation into the arms and legs. Radiating pain from the cervical spine and thoracic spine can also affect the back of the head and produce a headache. Back pain might radiate in the buttock and thigh in the lumbar spine. 

If the facet joints remain swollen, they might possibly impinge (press) on the nerve root that runs through these joints, resulting in numbness, tingling, burning, and pain in the arms and legs.

Whiplash and Facet Joint Pain

The term whiplash refers to a mechanical stress injury of the cervical spine. It occurs when a sudden force or movement strains the neck and spine, damaging muscles, ligaments, nerves, bones, and other nearby tissues. A whiplash injury most commonly occurs after an automobile accident.

A study on chronic whiplash-associated disorders identified whiplash injuries as a source of neck pain affecting the cervical facets in 54% of people. Most of these cases were related to automobile accidents in drivers and passengers.

Neck pain and headache are common symptoms of whiplash-facet injuries, especially those affecting the upper part of the cervical spine.

How Facet Joint Syndrome Is Diagnosed  

In diagnosing your neck or back pain, your healthcare provider will ask about your medical history, conduct a physical exam, and request imaging and diagnostic injection tests.

When asking about medical history, your healthcare provider will want to know about your symptoms and pain. They will also want to know when the pain started, current health conditions, any past or recent injuries, and your surgical history. 

For the physical exam, your healthcare provider will feel your back and neck for tender areas and check muscle reflexes to rule out nerve problems. They will also check your posture, range of motion, and muscle strength. 

If the physical exam and symptom history are not enough to make a diagnosis, imaging studies will be requested. This might include standard X-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans, and bone scans to view the facet joint and nearby structures.

An electromyography and nerve conduction studies might be done to measure the electrical activity in the nerves and muscles and identify nerve damage or compression.

An injection containing an analgesic (pain reliever) and a corticosteroid might be used as a means of diagnosis. It is given to the affected facet joint. A facet joint problem can be confirmed if it gives you pain relief. 

Treatment: Facet Injections

The same injections used to diagnose facet joint pain can also treat it. These injections can relieve pain even if you have had it for weeks or months. These injections are minimally invasive and pose little risk for complications.

Injections help manage facet joint pain in the lumbar, thoracic, and cervical regions. They can be given as nerve blocks or intra-articular (directly into the joint). 

These injections deliver a local anesthetic and a steroid medication directly into the affected facet joint. The local anesthetic numbs the joint to offer pain relief, while the corticosteroid relieves inflammation and swelling to offer long-term pain relief. 

Additional nonsurgical treatment options for managing facet joint problems include:

When Facet Joint Pain Is Serious

Most people can find relief with nonsurgical therapies. Rhizotomy surgery (also called radiofrequency ablation) may be considered to target the nerve roots that pass through the facet joints. This surgery uses chemicals or an electrical current to destroy nerve fibers that send pain signals to the brain.

Surgery might also be considered for facet joint pain related to:

  • Fractured or displaced facets
  • Facet joint pain caused by another condition, such as degenerative disc disease
  • A spinal tumor or large cyst
  • Cauda equina syndrome: Nerve compression of the cauda equina nerve roots (located at the bottom of the spinal cord) that affect the legs and bladder

Cauda Equina Syndrome

Cauda equina syndrome is a medical emergency. It should be treated quickly with decompression surgery to avoid complications like paralysis of the legs, bladder or bowel dysfunction, and persistent lower back and sciatica pain. 

Symptoms include severe lower back pain that radiates in the buttocks and thighs, saddle anesthesia (reduced sensation in the saddle and genital areas), muscle weakness of the legs, and significant bowl and urinary changes. 

If you believe you or a family member is experiencing signs of cauda equina syndrome, seek immediate medical attention. 

You should immediately contact a healthcare provider or seek emergency care for:

  • Back or neck pain that does not improve with rest and pain medications and becomes progressively worse
  • Pain that spreads to the arms and legs
  • Severe pain that keeps you up at night or affects your ability to perform daily activities 
  • Numbness, tingling, and weakness of the upper and lower limbs
  • Additional symptoms, such as fever, unexplained weight loss, fatigue, and skin rash
  • Trouble controlling your bladder or bowels
  • Pain after an injury or fall to the back or neck

Summary  

The facet joints are located at the back part of the spine, and each vertebra has one on each side. Facet joint disorders and pain are often the result of spinal degeneration, injuries, and arthritis conditions. Symptoms include pain, stiffness, and tenderness that may affect movement. 

Facet joint problems can be diagnosed based on medical history and with a physical exam, imaging, and diagnostic injections. Treatment might include pain medications, physical therapy, injections, and lifestyle changes, such as posture changes and staying active. Surgery is rarely needed to treat facet joint pain conditions. 

You should contact a healthcare provider for severe neck and back pain that extends to other body areas and affects the ability to carry out daily activities. Back and neck pain that results from an injury or fall needs medical attention.

Pain with additional symptoms like fever, fatigue, and bladder and bowel difficulties should also be taken seriously and brought to the immediate attention of a healthcare provider.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Lana Barhum

By Lana Barhum
Lana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease.