Facet joint syndrome

Facet joint syndrome is a frustrating condition. It causes unpredictable back and neck pain that can reduce your quality of life and keep you from doing the things you love.

Thankfully, you can manage the symptoms of facet joint syndrome through exercise. In this guide, we walk you through the causes, symptoms, and treatment of facet joint syndrome. We also introduce you to a number of exercises that can help you manage your facet joint pain.

Pierre Schydlowsky Specialist MD in rheumatology

Do you suffer from unpredictable back or neck pain that occurs off and on? Do movements like bending or twisting make your pain worse? Does changing position ease the pain? Do you feel a dull ache present directly over the spine? If any of these symptoms sound familiar to you, you might be suffering from facet joint pain. What is this condition and why do you have it? More importantly, what can you do to make the pain go away?

At Injurymap, we understand that neck and back pain can limit your lifestyle. It can prevent you from doing the things you love. With this comprehensive guide, we bring you all the information you need to understand facet joint pain. Read on to find out what you can do to treat and prevent this potentially debilitating condition. Remember, this guide is meant for information only. Please see a healthcare provider if your symptoms are severe or do not improve with home remedies.

Looking for a solution to your facet joint pain? Try the Injurymap exercise app now.

Content:

What is facet joint pain?
Can facet joint pain be cured?
Causes of facet joint pain
Symptoms of facet joint syndrome
Complications
Diagnosis of facet joint pain
Facet joint pain exercises
Other treatment options for facet joint pain
When to see a doctor
Does facet joint pain go away?

What is facet joint pain?

Before we dive into the causes and treatment of facet joint pain, let’s understand what the term means. The human spine is made up of individual bones called the vertebrae. These small bones are stacked one above the other. Each vertebra consists of three parts – a large disc and two projections behind it which are called facets. These three structures form a tripod that gives the spine stability and flexibility.1 It allows us to bend and twist while keeping the spinal bones linked together.

The facets of the vertebrae are linked to one another at the facet joints. Each joint is lined with cartilage and has a lubricating synovial fluid inside a joint capsule. When the facet joints are healthy, they glide easily and allow us to move our back and neck without pain. Healthy facet joints also keep the spine stable and prevent over-bending and over-twisting.1

Facet joints can be affected by arthritis, exactly like other joints in the body. Facet joint syndrome refers to a collection of symptoms. These symptoms are caused by an arthritis-like condition of the spine. Other names for this condition are facet arthropathy and facet joint osteoarthritis.2

The main symptom of facet joint pain is significant back and neck pain.1 The pain is caused by degenerative changes in the facet joints. In other words, the cartilage in the facet joints breaks down and becomes inflamed. The damage to the cartilage causes the bones in the joint to rub together, leading to symptoms such as pain, swelling, and stiffness.2

Can facet joint pain be cured?

In most people, facet joint pain is caused by the wear and tear associated with age. Even though there is no non-surgical cure for facet joint pain,3 the majority of people can manage the symptoms without surgery. Exercise can be an especially efficient way to reduce the symptoms. If conservative treatments do not offer relief from facet joint syndrome, surgery may be recommended.

Causes of facet joint pain

Facet joint pain occurs when the cartilage between the facet joints gets worn down and damaged2,4

Common causes of worn down facet joints
  • Osteoarthritis. This is an age-related breakdown of cartilage in the joints. It is most often seen in large joints like the knee and hip but can affect any joint in the body, including the spinal facet joints.>
  • Injuries. A fall, sports injury, or car crash can cause damage to one or more of the facet joints and lead to pain and other symptoms.
  • Occupation. Jobs that involve heavy lifting, repetitive movements, or poor posture can cause the facet joint cartilage to become worn out.
  • Age, gender, and ethnicity. Facet joint pain in the lumbar (lower back) region is more common among older individuals (ages 40 to 70) and in women. African-Americans have a substantially lower risk of facet joint osteoarthritis compared to Caucasians.
  • Heredity. There is evidence that facet arthropathy, which is a type of arthritis, may be linked to genetics. This means people who have family members with facet joint pain are more likely to develop it themselves.
  • Obesity. The risk of facet joint osteoarthritis is three times higher in people with a BMI between 25 and 30. Facet joint pain is five times more likely in individuals with a BMI between 30 and 35. (A healthy BMI ranges between 18 and 25 – you can calculate your BMI here).

As you can see, among all the causes and risk factors of facet joint pain, the easiest one to control is body weight. A healthy diet and regular workout program can help prevent obesity-related facet joint symptoms. The Injurymap app has some excellent workout programs. You can do Injurymap’s exercises at home to stay fit and maintain a healthy body weight.

Symptoms of facet joint syndrome

The main symptom of facet joint syndrome is pain. Several clues show whether the pain is coming from the facet joints in the spine.

Facet joint pain is usually intermittent (it comes and goes with periodic flare-ups). The flare-ups are unpredictable and can occur without any inciting event or obvious cause. But facet joint pain can sometimes be chronic (ongoing).

The pain is typically a dull ache that is diffuse (widespread) and is present directly over the spine. In the lower back, it can spread to the buttocks, but it rarely spreads to the front of the legs. In the neck, facet joint pain can spread to the shoulders and back of the head, but it rarely spreads to the arms. But the pain can be felt in the arms and legs if there is the formation of bone spurs (small projections or growths) that press upon the spinal nerves.

Sitting in one position for a long period (for example, during a long car ride) can make the facet joint pain worse. Standing and long periods of inactivity may also worsen the pain. Facet pain increases in severity with twisting or bending backward. Changing position may relieve the pain.1 A tell-tale feature of facet joint pain is that it is relieved by bending forward. This is because the spinal flexion posture (leaning forward) takes the pressure off the facet joints.

Depending on which facet joint is involved, you might find it difficult to stand up straight or get out of a chair. Your posture may become hunched over, or you may need to turn your whole body to look to the side.9

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Complications

Sometimes facet arthropathy causes other conditions to develop. One of the complications of facet joint arthritis is bone spur formation. Bone spurs are small bony growths that reduce the space available for nerves in the spinal canal. This condition is called spinal stenosis (stenosis means narrowing). Bone spurs irritate the nerves, causing symptoms such as pain, numbness, and weakness in the buttocks and legs.5

Facet joint arthropathy is often associated with another condition called degenerative disk disease (DDD). DDD occurs with age where the vertebral disks become worn out. They lose their flexibility and shock-absorbing ability. All this can add to the back pain associated with facet joint arthropathy.

Diagnosis of facet joint pain

Facet joint pain is unpredictable and can be hard to pin down. But doctors can accurately diagnose whether the facet joints are the source of your pain. The evaluation will include a history and physical examination. This helps to identify the type and location of the pain. The doctor will also ask what makes the pain worse or better. You will be asked about any history of injury. During the examination, the doctor might manipulate your joints and ask you to move in different directions to see what makes the pain worse.1

Imaging tests such as X-ray, CT scan, and MRI can help confirm the diagnosis of facet joint pain by demonstrating abnormal changes in the facets.

A facet joint block is an injection of local anesthetic and steroid medication into a suspicious facet joint. This is sometimes performed to make a diagnosis. If there is a relief of symptoms while the drugs are active, it confirms that the symptoms are coming from the facet joint.6

Facet joint pain exercises

Facet arthropathy is a degenerative condition that cannot be reversed. But the pain can be managed with stretching and strengthening exercises. Here are some exercises you can do to help relieve facet joint pain:

  1. Lying glute stretch
    30 sec. x 3 sets

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    • Lie on your back and grab your knee with the hand on the same side.
    • Use the other hand to slowly pull your lower leg and knee towards the opposite shoulder.
    • Make sure your knee is bent at a 90-degree angle.
    • Repeat the exercise with both legs.
    • Keep the stretch for 30 seconds with both the left and right leg.
    • Perform 3 sets.
  2. Pelvic tilt on the floor
    10 reps

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    • Lay down on your back.
    • Alternate between elongating the left and right legs by turning the pelvis.
    • Make sure to perform the exercise at a relaxed pace.
    • Repeat the movement 10 times in both directions.
  3. Lying pelvic lift
    3 reps x 1 sets

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    • Lie on your back with bent knees and your feet placed flat on the floor.
    • Lift the pelvis up align your body with it with your thighs.
    • Tilt your pelvis backward and suck in your belly button.
    • Slowly lower your back again by placing a small part of your back into the ground.
    • Make sure to control the movement so that you start by letting the upper part of the back hit the ground first and the pelvis hits the ground last.
    • The exercise should improve your control of each backbone.
    • Make sure to perform the exercise at a relaxed pace.
    • Repeat the exercise 3 times.

Other treatment options for facet joint pain

The best way for you to successfully treat facet joint pain for the long-term is with exercise. It’s important that you do the exercises properly with the correct technique. The Injurymap app demonstrates the correct posture for each exercise so you can follow along easily at home. Besides exercise, there are other ways to treat facet joint pain. Some of them are listed below.

  • Posture correction: You can treat and prevent facet joint pain by maintaining a good posture in which the spine has a normal curvature. For example, you can pull the car seat forward and support the low back during a long car ride.6 It’s also a good idea to take occasional rest breaks and stretch the back if you have a long commute.

  • Hot and cold therapy: During an episode of pain, ice and heat application can help ease symptoms.

  • Medications: Non-steroidal anti-inflammatory medications (ibuprofen and acetaminophen) are pain-relieving drugs. They are available over-the-counter for short-term use.

Besides the conservative treatments mentioned above, there are some more invasive treatments for severe or persistent facet joint pain.

  • Steroid injection: Injection of steroid medicine and local anesthetic into the facet joints can offer longer lasting pain relief. This is also diagnostic of the condition, i.e., relief of pain after the injection confirms that the facet joint is the source of your pain.

  • Radiofrequency ablation: The doctor first performs a diagnostic facet block (injection of local anesthetic and steroid medication). This helps confirm the source of the pain. Once the painful facet joint is identified, a needle is inserted under X-ray guidance to the correct site. Radio waves are then used to burn the nerves. This prevents them from sending pain signals to the brain. The procedure is called radiofrequency ablation.7 It can provide pain relief for up to 2 years.1

  • Facet rhizotomy: This is a procedure in which an electric probe is used to destroy the nerve endings in painful facet joints. This provides relief of pain because the nerves that carry the pain signals to the brain are destroyed.6

  • Facet debridement: This is a minimally invasive procedure (keyhole surgery) in which the surgeon removes some of the damaged tissue from the facet joint.

  • Spinal fusion: If the pain from facet arthropathy is severe and not relieved by non-surgical treatments, the doctor may recommend spinal fusion surgery. This procedure stops motion at the level of the painful facet joints and decreases pain from the joint.8

When to see a doctor

In the majority of people, facet joint pain can be managed with conservative treatments and home exercises.1

Symptoms you should be extra aware of
  • The back or neck pain does not improve with rest, pain medication, and exercise.
  • The pain has spread to the arms or legs.
  • The pain is severe and prevents you from performing daily activities or keeps you up at night.
  • You experience numbness, tingling, or weakness in the arms or legs.
  • You have other symptoms such as fever, redness of the skin, or unexplained weight loss.
  • You have trouble controlling your bladder or bowels.

Does facet joint pain go away?

Facet joint pain tends to come and go. The pain gets worse with activities like twisting, bending, and lifting. Because the episodes are recurrent and erratic, they are sometimes brushed off as “it’s all in your head.” This can be discouraging for a person who has symptoms of facet joint pain. What can make the situation even more disheartening is that the degeneration in the spine worsens with time. The good news is that facet joint pain can be managed successfully without surgery in most cases. You can live a healthy and active life despite facet arthropathy. There are several effective treatment options available.

Some of the factors that increase your risk of developing facet arthropathy are out of your control. These include your age, gender, and ethnicity. But there are things you can do to prevent, delay, and treat facet joint pain. Make sure you maintain a good posture. Keep your body weight within a healthy range. Perform regular stretching and strengthening exercises. This can slow down facet joint degeneration and reduce stress on the spine.

The Injurymap app has a range of back and neck stretches and strengthening exercises. Make it a habit to include these exercises in your daily workout. This will help improve control of the backbone and stretch out the facet joints to reduce and prevent pain. The app demonstrates the correct way to perform each exercise so that it’s easy to follow along at home.

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About the author

Pierre Schydlowsky is a specialist MD and Ph.D. of rheumatology with a diploma in sports medicine. He has published multiple research papers on shoulder and ski injuries and is teaching various advanced courses in sports medicine at Danish Universities.

References:

  1. https://www.mayfieldclinic.com/pe-facet.htm ↩

  2. https://www.medicalnewstoday.com/articles/320355 ↩

  3. https://drtonymork.com/back-pain/facet-syndrome/what-is-facet-joint-syndrome/ ↩

  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012322/ ↩

  5. https://www.healthline.com/health/facet-arthropathy#complications ↩

  6. https://www.spine-health.com/conditions/arthritis/symptoms-and-diagnosis-facet-joint-problems ↩

  7. https://my.clevelandclinic.org/-/scassets/files/org/neurological/spine/lumbar-radiofrequency-ablabtion-2016.ashx?la=en ↩

  8. https://www.southdenverneurosurgery.org/services/spine-surgery/facet-arthropathy ↩

  9. https://www.cedars-sinai.edu/Patients/Health-Conditions/Facet-Joint-Syndrome.aspx ↩

  10. http://www.thespinehealthinstitute.com/news-room/health-blog-news/5-signs-its-time-to-see-a-doctor-for-your-back-pain ↩