Facet Joints 101

By Rishi Vora DO and Susan Sorosky MD

The facet joints are located throughout the spine and are a common source of neck and back pain. Where are these joints? What is facet syndrome? How do I know if my spine pain is coming from a facet joint? Can pain from a facet joint be treated? Keep reading, and we will delve into all of these questions in this month’s blog: Facet Joints 101.

The facet joints come as pairs on each side of the spine and are found in all regions (cervical, thoracic, and lumbar). Like other joints, they have cartilage on the inside and are lubricated with synovial fluid. These joints have a different orientation in each region of the spine to allow for specialized movement.¹ For example, In the cervical spine (neck), the joints allow for a significant amount of rotation; the thoracic (mid back) region has the least mobility but has greater stability; and in the lumbar spine (lower back), the facets allow for greater bending with less rotation.²

Facet-mediated pain or facet syndrome is the painful condition of these joints when they are irritated, inflamed, or arthritic. Facet pain can be caused acutely by trauma such as overly bending or hyper-extending. Whiplash is a common cause of acute pain in the cervical facet joints. More commonly, facet syndrome develops insidiously over time due to degenerative changes and osteoarthritis. With aging, discs in the spine degenerate which increases the load on the facet joints leading to cartilage erosion and bony hypertrophy (enlargement). Prior injury can also be associated with chronic facet pain; for example, facet-mediated pain is the most common diagnosis in patients with chronic neck pain after a motor vehicle collision. Postural stress, excess weight, and muscle tension can also contribute to facet syndrome.³

What does facet pain feel like? Typically, a person experiences localized pain on the side of the spine which can refer to another area. For example, in the cervical spine, the pain can radiate into the head⁴ or into the shoulder and scapular (shoulder blade) region, and in the lumbar spine, there may be referral into the hip and gluteal region or the thigh. There is often an accompanying restriction in spinal range of motion such as rotation in the neck and extension (arching back) in the lower back. Facet joint pain is often worse in the morning and with long periods of immobility such as standing or arising from sitting after a long period (lower back). The area may be tender to touch and associated with muscle tightness or spasm in the immediate area surrounding the joint.

Are there effective treatments for facet syndrome? Yes! Physical therapy especially with a manually trained therapist can reduce pain, restore proper spinal motion and correct muscular imbalances. In addition, a short course of anti-inflammatory medication and modalities such as ice and heat can also be helpful.⁵ Finally, there are interventional procedures that can help reduce pain and improve mobility. While a steroid injection into the joint can ease inflammation and relieve pain in the short term, a procedure called radiofrequency ablation (RFA) (also known as “burning the nerves”) is a more long lasting option. This intervention targets the medial branches of the spinal nerves, which are the nerves that transmit pain from an inflamed or arthritic joint. There is a substantial amount of evidence-based literature which has shown that RFA can relieve facet-mediated pain for 6-12 months in more than 70% of patients and in some cases for years.⁶ If you are experiencing neck or back pain and think you might have pain coming from your facets, contact us at Desert Spine and Sports Physicians where we are experts at the diagnosis and non-surgical management of musculoskeletal pain and injury including facet syndrome.

1 https://www.spineuniverse.com/anatomy/facet-joints-spines-anatomy
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705911/
3 https://www.ncbi.nlm.nih.gov/books/NBK538228/
4 https://www.ncbi.nlm.nih.gov/pubmed/23481329
5 https://www.spine-health.com/conditions/arthritis/treatment-options-facet-joint-pain
6 https://www.webmd.com/arthritis/radiofrequency-ablation