What Is Facet Joint Syndrome and How It Causes Back Pain

When we think about back pain, we often imagine strained muscles, herniated discs, or poor posture. But nestled in your spine are tiny joints that quietly do a lot of the heavy lifting—literally. These are your facet joints, and when they become irritated or inflamed, they can trigger a condition called facet joint syndrome. Though lesser known than other spinal disorders, this syndrome is a common, and often underdiagnosed, cause of persistent back pain.

In this blog, we explore what facet joint syndrome is, its causes, how it leads to back pain, and what you can do about it.

What Are Facet Joints?

Facet joints are the small, bony articulations between each pair of vertebrae in your spine. There are two of them per vertebra, one on each side, acting as hinges that:

Guide and limit movement between spinal segments
Support weight transfer across the spine
Help maintain stability and alignment

Each facet joint is surrounded by a capsule and lined with cartilage, enabling smooth and controlled movement. They also contain small nerve endings that can transmit pain signals when irritated.

What Is Facet Joint Syndrome?

Facet joint syndrome, also referred to as facet arthropathy or facet joint disease, is a degenerative or inflammatory condition affecting these joints. It occurs when the facet joints become:

Inflamed due to repetitive stress or injury
Worn down by osteoarthritis
Irritated due to poor spinal alignment or instability

The resulting inflammation, swelling, or joint dysfunction can compress nearby spinal nerves or trigger referred pain in the back, hips, shoulders, or even limbs, depending on the location of the affected joint.

Common Causes of Facet Joint Syndrome

Several factors can contribute to the onset of facet joint syndrome, including:

Age-related degeneration: Over time, the cartilage that lines the joints wears down, leading to increased friction, inflammation, and pain. Read more about how muscle loss in ageing contributes to joint degeneration.
Repetitive stress: Jobs or activities that involve bending, twisting, or prolonged sitting can overwork the facet joints.
Poor posture: Misalignment from prolonged slouching or forward head posture increases the load on the joints.
Spinal trauma: Sudden injury from car accidents, falls, or sports can damage joint surfaces or capsules.
Disc degeneration: When intervertebral discs shrink, more pressure gets transferred to the facet joints, accelerating wear.

Symptoms of Facet Joint Syndrome

The symptoms can vary depending on which region of the spine is affected. However, common signs include:

Localised back pain that may be dull, aching, or sharp
Stiffness and difficulty with movements like bending or twisting
Pain that worsens with activity, particularly when standing or leaning backwards
Referred pain to the buttocks, shoulders, or thighs (but rarely past the knees or elbows)
Muscle tightness or spasms, especially around the spine

If the syndrome is in the lumbar spine, it may feel like a deep ache in the lower back or hips. If it's in the cervical spine, it may result in neck stiffness or headaches.

How Facet Joint Syndrome Causes Back Pain

Facet joints contain small nerve endings. When the joint capsule becomes inflamed or swollen, it irritates these nerve endings, triggering pain signals. Here’s how this plays out:

Joint Compression and Swelling: Swollen joints compress surrounding tissues and nerves, producing localised and radiating pain.
Muscle Compensation: When joints lose their smooth gliding function, nearby muscles tense up to stabilise the spine, resulting in spasms and fatigue.
This is why some individuals try different approaches, such as massage therapy versus stretching, to alleviate chronic muscle tightness.
Referred Pain Patterns: The nerve-rich joint capsules can send signals to distant parts of the body, often mimicking disc issues or sciatica.
Mechanical Imbalance: With one or more facet joints inflamed, spinal alignment gets disrupted. This may trigger secondary pain in adjacent areas.
Even subtle changes in your walking patterns can impact the spine’s loading mechanics and worsen pain over time.

Diagnosing Facet Joint Syndrome

Facet joint syndrome can be challenging to diagnose because it often mimics other spinal conditions. Diagnosis typically involves:

Physical examination: Checking pain responses to spinal movement or pressure on specific joints
Imaging tests: X-rays, CT scans, or MRI scans may show joint degeneration or inflammation
Diagnostic injections: A local anaesthetic is injected into the suspected facet joint. If pain relief follows, the joint is confirmed as the source of the problem.

Treatment Options

The good news is that many individuals with facet joint syndrome respond well to non-surgical interventions. Treatment is usually tiered:

1. Conservative Management

Physiotherapy: Focuses on core strengthening, spinal stabilisation, and posture correction.
Heat or ice therapy: Reduces muscle spasms and inflammation.
Lifestyle modifications, including ergonomic adjustments, movement breaks, and hydration, play a significant role in reducing joint stress.

In fact, even your water intake matters. Hydration directly supports spinal disc health and may ease inflammation around the joints.

2. Medical Interventions

Medication: NSAIDs, muscle relaxants, or corticosteroids can reduce inflammation and pain.
Facet joint injection: Steroid injections or medial branch blocks offer temporary pain relief and confirm the diagnosis.
Radiofrequency ablation (RFA): If injections help, a longer-term solution may be to “burn” the nerves transmitting pain using heat (RFA).

3. Surgical Options (Rare)

Surgery is generally reserved for those with severe or unmanageable pain who haven’t responded to conservative care. Procedures may include spinal fusion or joint denervation.

Lifestyle Factors That Can Worsen Pain

Facet joint pain isn’t just structural. It’s also affected by your broader health habits. A few key factors that may aggravate symptoms include:

Sleep deprivation, which increases pain sensitivity and delays healing
Unmanaged stress, which contributes to muscle tension and chronic pain. Explore the link between stress and back pain

Together, these invisible contributors can heighten your perception of pain and reduce your resilience to spinal stress.

When to See a Specialist

You should consult a physiotherapist or spine specialist if:

Pain lasts longer than 2–4 weeks
Symptoms worsen despite rest
Pain interferes with sleep or daily activities
You suspect joint stiffness or instability in addition to pain

Getting a clear diagnosis can help you avoid unnecessary scans or treatments and allow for a personalised plan to manage your pain long-term.

Final Thoughts

Facet joint syndrome may not be a household name, but it’s a frequent and manageable cause of spinal pain. With early diagnosis, thoughtful movement, and the right support, you can minimise flare-ups and enhance your overall quality of life. Remember: back pain is not something you have to “just live with.”

Explore your options, talk to your care team, and stay proactive.

References

This article is reviewed by Dr. Anurag Gupta, a gold medalist in MPT-Sports Physiotherapy, has worked with elite international and national athletes across football, tennis, and badminton. His clientele includes Srikanth Kidambi (#1 Men’s Badminton Player, Arjuna Awardee, Padma Shri) and Hendra Setiawan (Olympic Gold Medalist, 4x World #1 in Men’s Badminton).

Beyond athletes, Dr. Gupta is the preferred physiotherapist for top founders, including Vivek Gupta (Licious), Rishabh Telang (Cult.fit), and Arjun Chaudhary (former MFine), helping them recover from musculoskeletal issues efficiently.

What Is Facet Joint Syndrome and How Does It Cause Back Pain?

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