Facet joint syndrome
The joints in the spine are called “facets.” Each vertebra in the spine has two sets.
Facet joint syndrome is caused by natural wear and tear on these facets over time, causing pain. The syndrome is most commonly found in the lower back (lumbar) and neck (cervical).
Symptoms of facet joint syndrome
Depending on the number of facets involved and the magnitude of the disorder, patients suffering from Facet Joint Syndrome may experience the following symptoms:
- Localized pain. Facet joint pain is usually described as being a dull ache in the lower back.
- Referred pain. When pain is “referred,” it means it appears in a different part of the body than the actual source of the pain. Facet joint pain may be referred to the buttocks, hips, thighs or knees. It can also be felt in the abdomen and/or pelvis.
- Radiating pain. Sometimes patients experience a sharp, shooting pain (sciatica) that may radiate into the buttock, thigh, leg and/or foot. Muscle weakness and fatigue may also occur in the affected leg.
- Tenderness to the touch. The pain may intensify when light pressure is applied to the skin over the irritated facet.
- Effect of posture and activity. Patients may find that their pain is higher in the morning, following heavy exercise, after sitting still for long periods of time and/or while rotating or bending the spine backward. Conversely, bending forward may relieve the pain. Extended periods of sitting still, like while driving a car, may further increase the pain.
- Stiffness. Stiffness is likely to occur early in the morning or after extended periods of inactivity. Once physical activity is resumed, the area will loosen up and patients will typically experience relief.
- Crepitus. Arthritic changes in the facets may cause a feeling of grinding or grating in the joints upon movement.
Causes of facet joint syndrome
Facet joint syndrome is most commonly found in the neck (cervical region) and lower back (lumbar) and is caused by natural wear and tear on the joints (facets) over time.
Because the lumbar facets in the lower back bear the weight of the upper back and are subject to sustained stress from twisting and bending, they can start to break down and become fragile. As they degenerate over time, they can eventually become the epicenter to a significant amount of lower back pain.
Other factors that may cause facet syndrome include:
- Being overweight or obese.
- Fractures of the spine.
- Poor posture.
- Repetitive bending or twisting.
- Sedentary lifestyle.
- Sudden, vigorous stretching.
- Torn ligaments.
- Trauma, such as an accident, fall or sports injury.
Facet joint syndrome can afflict both men and women and is most commonly seen in people between the ages of 40 and 70. In addition to occurring in those prone to arthritis, it also may develop in people who’ve had a spine injury or trauma.
Treatments for facet joint pain
Your doctor will recommend conservative therapies to start with, including suggestions on self-care, physical therapy and medications. A full range of nonsurgical treatments are available, and several are typically done at the same time.
If those first-line treatments fail to help you manage and control the facet pain, your doctor may then recommend injections, ablations or surgery.
Nonsurgical treatments for lumbar facet joint pain
- Applying heat therapy.
- Engaging in low-impact exercises.
- Staying active.
- Supporting the lumbar curve.
- Using a cold pack.
- Using a supportive brace.
Self-care. Keeping correct posture and making sure your spine stays in alignment are important things you can do to avoid pain as much as possible. This may also require you to adjust your daily standing, sitting and sleeping habits.
One of the best ways to reduce the stress on facet joints and therefore reduce pain is by losing weight.
Physical therapy. Although it may seem counterintuitive, exercise is very effective in treating facet joint syndrome and can help speed up the healing process. Physical therapists can provide direction on the right way to lift objects and insight into proper walking techniques. They’ll also work with you to strengthen and stretch your lower back, leg and stomach muscles.
As with any suggested treatment, the results you can expect from the strengthening and stretching exercises they show you are directly proportional to your ability to follow them consistently.
Medications. Your doctor may recommend oral anti-inflammatory medications or topical patches, creams or salves. If muscle spasms become an issue, your doctor may also prescribe muscle relaxers to help stop them from occurring.
Steroid joint injections. Steroids can help reduce the swelling and inflammation of the nerves in the facet joint. During this minimally invasive procedure, corticosteroid and an analgesic-numbing agent are injected into the painful joint. This can provide pain relief that can last from days to years. When done in tandem with physical therapy and exercise, steroid joint injections can help improve your condition. If needed, the procedure can be repeated.
Nerve radiofrequency ablation. This procedure, which begins with a diagnostic nerve block test to determine which nerves need to be treated, might be necessary if steroid joint injections don’t provide long-term relief from pain. After the nerve block test is completed, the next step is to inject anesthetic along the nerve to “block” pain. If that part of the procedure works, your doctor will proceed with a radiofrequency ablation in order to attain longer lasting pain relief.
The procedure for nerve ablation works a lot like a nerve block. Once the needle is in position to place the electrode, a radiofrequency current is used to destroy some of the medial branch nerve fibers carrying pain signals in the joint. This procedure typically provides pain relief for 9 months to up to more than 2 years. It’s important to remember that there’s always a possibility that the nerve will eventually regrow through the burned lesion that was created.
Surgery
If your pain doesn’t respond to treatment via nonsurgical care options, or if you’ve experienced a more severe trauma like a complex fracture, significant dislocation or spinal cord involvement, surgical intervention may be recommended. One of these options is spine fusion surgery, a procedure that is typically recommended when there is additional damage from degenerative disk disease or there’s weakness in the spine.
Frequently asked questions (FAQs) about facet joint pain
Do facet joint problems show up on an MRI?
Yes. Your doctor has several options when choosing the type of imaging they want to use to check the facet joint and adjacent structures. Between standard x-rays, medical resonance imaging (MRI), computed tomography (CT) scans and other specialized tests, MRI is considered the best option for diagnosing and evaluating lumbar facet joint disease.
Is walking good for facet joint pain?
Yes. Incorporating simple, low-impact exercises, such as walking, into your daily routine may help alleviate facet joint pain when done in moderation, meaning not overexerting yourself and only walking short distances. Taking short walks on a regular basis can help offset the pain and stiffness typically experienced from extended periods of inactivity, like sitting in an office chair, driving a car or after waking up in the morning. Walking also improves strength and flexibility in the lower back.
References
National Center for Biotechnology Information (NCBI): National Library of Medicine. Facet joint syndrome: from diagnosis to interventional management (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206372/)
American Society of Anesthesiologists. Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint Pain (https://pubs.asahq.org/anesthesiology/article/106/3/591/7598/Pathogenesis-Diagnosis-and-Treatment-of-Lumbar)