Facet joint pain Is your back pain coming from the facet joints?

Many people with long-lasting back pain have been told they have “arthritis in the spine.” Often that means facet arthritis, and sometimes the facet joints really are the main pain generator. Sometimes they are not. The videos on this page show how our physicians test for facet joint pain and how it is treated when the test is positive. For every back condition we treat, see our lower back pain treatment page.

What are the facet joints?

Each vertebra connects to the ones above and below through a pair of small joints at the back of the spine, one on each side. They guide and limit movement when you bend, twist and lean back. Like a knee, each facet joint has cartilage and a joint lining, so wear, an old injury or repeated strain can make it stiff and painful. Facet arthritis is most common in the lower back and the neck, and it becomes more common after middle age. Together with disc wear in the lower back, it is part of lumbar spondylosis.

Facet joint pain symptoms

• A deep ache on one or both sides of the spine rather than in the middle
• Pain that is worse after standing for a long time, leaning backward, twisting or getting up after sitting (see back pain when standing for other possible causes)
• Pain that eases when you bend forward, sit or lie down
• Stiffness first thing in the morning that loosens as you move (see back pain in the morning)
• Pain that spreads into the buttock or upper thigh (lower back) or the shoulder blade or back of the head (neck), but rarely below the knee

Pain that shoots below the knee with numbness or tingling points more toward an irritated nerve root; our post on transforaminal epidural injections for sciatica covers that pattern. Our guide to finding the cause of chronic pain explains why the place that hurts is not always the source.

How a medial branch block confirms the source

Facet arthritis shows up on X-rays and MRIs of many people who have no pain at all, so a scan alone cannot prove the joints are the problem. In the first video, an animation highlights the facet joints on both sides of the lower spine before a physician performs a medial branch block. The medial branch nerves carry pain signals from the facet joints. Using live X-ray (fluoroscopy), the physician places a small amount of numbing medicine next to those nerves at the levels that match your exam, as the second and fifth videos also show.

Afterward you track your usual pain for the next several hours, ideally doing the things that normally hurt. A large drop means the facet joints are likely the source. Learn more about the medial branch block and how it is done.

Radiofrequency ablation for facet joint pain

When a test block works, radiofrequency ablation (RFA) is the longer-lasting step. The third video shows the idea: a probe tip placed next to the medial branch nerve is heated with radiofrequency energy, which stops that nerve from carrying pain signals from the joint. Relief often lasts many months, and because nerves slowly regrow, it can be repeated if pain returns. RFA treats the pain, not the arthritis itself. Read more about radiofrequency ablation for back pain; a similar approach for knee arthritis is genicular nerve ablation.

Why exercise still matters

Procedures quiet the pain; exercise helps keep it quiet. Strengthening the deep trunk and hip muscles, improving how you bend, lift and stand, and regular mobility work help the facet joints tolerate daily load. Physical therapy is offered at our Brooklyn and Staten Island offices, and our guide to chronic back pain treatment covers the other non-surgical options.

What you can do at home

• Break up long periods of standing with short sits, and long sitting with short walks
• Use heat for morning stiffness, 15 to 20 minutes at a time
• Avoid holding the back arched, for example when reaching overhead for a long time
• Keep walking. Short, regular walks usually help more than rest

When to see a doctor

See a physician if back or neck pain lasts more than a few weeks, keeps coming back, or limits work and sleep. Go to an emergency room or call 911 for back pain with loss of bladder or bowel control, numbness in the groin, sudden leg weakness, or fever.

Related care at Precision Care Medical & Sports Performance

Facet joint pain treatment near you

Precision Care Medical & Sports Performance pain management physicians evaluate facet joint pain at all three offices. In Brooklyn, Ashley Marcus, MD sees patients at our Brooklyn pain management office, close to Sheepshead Bay, Manhattan Beach and Gravesend, so if you have searched for RFA in Brooklyn, that is the place to start. On Staten Island, Jake Stephen, DO sees patients for pain management on Staten Island, convenient to New Dorp, Great Kills and Oakwood. Both offices also offer physical therapy.

In Manhattan, Yuri Gordin, MD leads the Precision Care Spine & Pain Center in Midtown Manhattan at 150 E 55th St, a direct trip for patients from Spanish Harlem (East Harlem), Washington Heights and the Upper West Side, and the nearest office for anyone looking for RFA in Midtown East. Physical therapy is not offered at the Midtown Manhattan office. Pain procedures are performed at all three offices, and your physician explains where and when yours will be scheduled. Looking for facet joint pain treatment near me? Request an appointment or call the office closest to you.

Questions patients ask

Educational only, not medical advice. These videos and this article explain common problems and treatments in general terms. They are not a diagnosis or a treatment plan for you. Results vary from person to person. See a qualified clinician about your own symptoms, and call 911 or go to an emergency room for an emergency.

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