How do I know if my back pain is coming from my facet joints?

The classic clinical pattern is localised one-sided lower back pain that worsens with extension and rotation, eases with forward flexion and sitting, and often refers into the buttock or posterior thigh but not below the knee. Cohen and Raja and subsequent consensus guidelines (Cohen et al. 2020) note that no single clinical test is definitive. Facet joint pain is a clinical diagnosis supported by examination, with diagnostic medial branch blocks reserved for cases being considered for interventional procedures.

Does my MRI have to show facet arthritis for this to be the problem?

No. Imaging findings do not correlate neatly with symptoms. You can have significant facet arthritis on MRI with no pain, and symptomatic facet-driven pain with a relatively unremarkable scan. The clinical presentation carries more weight than the imaging report.

Is facet joint pain just arthritis, and does it get worse with age?

Facet joints change with age in almost everyone. Whether those changes drive pain depends more on load management, strength, and movement quality than on the presence of arthritis itself. People with the same imaging can have very different clinical pictures.

Should I avoid arching my back entirely?

Not long-term. Short-term, it makes sense to reduce provocative extension and rotation, particularly combined (like looking up to a ceiling while twisting). The goal is to desensitise, then progressively re-load extension so you tolerate normal function, including reaching overhead, sleeping on your stomach briefly, and looking up, without a flare. Complete avoidance tends to make the segment more sensitive rather than less.

Will I need a facet joint injection or radiofrequency ablation?

Usually no. Most facet-driven presentations respond to manual therapy combined with progressive strengthening and movement re-education. Interventional procedures are typically considered when symptoms remain significantly disabling after at least 3 months of appropriate conservative care and when two diagnostic medial branch blocks reproduce at least 80% relief, consistent with current consensus guidance.

Why does walking help but standing still does not?

Standing in one position loads the facets continuously in a mildly extended posture. Walking changes hip and spine position on every step, briefly unloading each facet and sharing load across the hip extensors and trunk. That is also why leaning on a shopping cart, standing with one foot on a step, or shifting weight frequently often takes the edge off.

Facet Joint Syndrome

Facet joint pain and dysfunction

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The Science of Facet Joint Syndrome

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Facet joints are small joints between vertebrae that guide and limit movement. They can become arthritic or inflamed, causing localized back pain. The joint capsule is richly innervated, making it a significant pain source.

Conditions I commonly see alongside, or confused with, this one.

Low Back Pain
Anatomically related
Facet joints are common source of mechanical low back pain
Degenerative Disc Disease
Common co-occurrence
Disc degeneration increases load on facet joints leading to arthritis
Spinal Stenosis
Common co-occurrence
Facet joint hypertrophy can contribute to spinal canal narrowing

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Facet Joint Syndrome

The Science of Facet Joint Syndrome

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