Understanding Facet Joint Pain and Treatments

What are Facet Joints?

The spine, also called the vertebral column, is composed of uniquely-shaped bones called vertebrae.  From skull to tailbone, these 33 vertebrae are stacked one on top of the other, and are connected by facet joints. There are two sets of facet joints, also called Z-joints, between each pair of adjacent vertebrae, and they form where the two bones meet.

How do Facet Joints Function?

Facet Joints Stabilize and Allow Movement

Facet joints act as spine stabilizers by limiting movement and keeping vertebrae in place. On the other hand, facet joints also allow the bones of the spine to articulate, or move. A facet joint is lined with cartilage, and surrounded by connective tissue which produces lubricating synovial fluid. This cartilage and synovial fluid allows the two vertebrae to move over each other smoothly.

In this way, facet joints allow the spine to:

  • flex forward
  • extend backward
  • bend side to side
  • twist (rotate)

What Causes Facet Joint Pain?

Specifically, facet joint issues cause pain when the nerves supplying the joints are affected. Facet joints are supplied by medial branch nerves which send pain signals from the spine to the brain. Injury to the spine, inflammation and degeneration of cartilage and connective tissue due to overuse, infection or disease are all potential causes of facet joint pain.

What are Facet Joint Pain Symptoms?

Symptoms will look different depending on the underlying cause of the pain, and what part of the spine is affected.

  • Loss of spinal flexibility (guarding)
  • Joint pain and tenderness
  • Intermittent, unpredictable severe pain episodes

Cervical (Neck) Facet Joint Syndrome:

  • Radiating pain down the neck, upper back, shoulders
  • Headaches
  • Popping/clicking noises when moving head side to side, or up and down

Lumbar (Lower Back) Facet Joint Syndrome:

  • Radiating pain down buttocks and upper leg
  • Popping/clicking noises or “catching” sensations in lower back
  • Difficulty with standing, walking and bending backwards

How are Facet Joint Problems Diagnosed?

In order to prescribe the most appropriate treatment, an orthopedic specialist will need to determine if a patient’s pain is being caused by problems with the facet joints, or if other spinal or muscular issues are to blame. If you are experiencing back pain and symptoms of facet joint pain, consult an orthopedic specialist or your primary care physician.

To obtain a diagnosis, a doctor will gather information through:

  • Patient’s medical history and symptom reports
  • Visual examination of the spine and patient’s range of motion
  • X-rays, magnetic resonance imaging (MRI) or computed tomography (CT) scans of the spine
  • Medial Branch Block: Outpatient therapeutic injection of numbing medicine into medial nerves supplying suspected facet joints. If anesthetizing these nerves results in pain relief, then it is clear the facet joints are the cause of pain. This procedure can be used as a diagnostic tool, and as a treatment.

What are Treatments for Facet Joint Pain?

  • Medication: Over-the-counter (OTC) pain relievers such as NSAIDs, and prescription muscle relaxants and steroids can provide temporary pain relief.
  • Applying heating pads and ice packs
  • Postural adjustments: Changing sitting and standing habits can reduce stress on the neck and back
  • Exercise and physical therapy: Prescribed daily stretches and strengthening exercises improve flexibility and movement integrity.  These practices can also relieve pain by increasing circulation and decreasing inflammation.
  • Avoid activities that cause pain: Whenever possible, minimize the amount of time spent performing painful activities, or alter activities to eliminate excessive twisting or bending.
  • Cortisone Steroid Injections
  • Medial Branch Block
  • Radiofrequency Ablation (Rhizotomy)