Facet joint pain, also known as facet arthropathy or facet syndrome, affects the small joints along the back of the spine. These joints provide stability and guide spinal movement. While aging can lead to some degeneration, pain occurs when they become inflamed or arthritic, impacting daily life. Facet joints are a common source of chronic spinal pain, affecting 15% to 45% of individuals with low back pain, 42% with thoracic pain, and 54% to 67% with neck pain.
Understanding Facet Joint Pain
Facet joints are small, paired synovial joints connecting the vertebrae. They are covered with cartilage and surrounded by a lubricating capsule. Their primary function is guiding and limiting the spine’s range of motion while bearing some vertical forces. When these joints experience wear, tear, or inflammation, they can become a source of pain.
Symptoms often include localized aching and stiffness in the neck, middle, or lower back. This discomfort worsens with movements like twisting, standing, or bending backward, and is more noticeable after inactivity. Pain can also extend to the back of the head, shoulders, buttocks, hips, or thighs, though it rarely extends below the knee. Stiffness may also make it difficult to stand upright or get out of a chair.
Non-Invasive Treatment Options
Initial approaches to managing facet joint pain involve methods aimed at reducing inflammation and improving function. Physical therapy plays a central role, focusing on strengthening muscles, improving flexibility, and correcting posture. A physical therapist guides individuals through specific exercises to stabilize the spine and relieve joint pressure. Techniques like joint mobilization can also help improve movement.
Medications are often used to alleviate pain and inflammation. Over-the-counter options include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, which reduce inflammation. Acetaminophen is another option for pain relief, though it does not reduce inflammation. For more severe pain or muscle spasms, a healthcare provider might prescribe stronger anti-inflammatories or muscle relaxants. Topical creams, gels, or patches can also be applied directly to the affected area for local relief.
Heat and cold therapy can provide effective relief. Cold therapy, such as an ice pack, is recommended for acute pain or flare-ups, especially within the first 24 to 72 hours, as it helps reduce swelling and inflammation. Heat therapy, including heating pads, is beneficial for chronic pain or muscle stiffness, as it increases blood flow and relaxes muscles. Some individuals find alternating between hot and cold therapy most effective.
Activity modification and lifestyle adjustments are also important. This involves avoiding movements that aggravate pain and maintaining a healthy weight to reduce stress on the spine. Gentle exercise, such as walking, swimming, or tai chi, can improve mobility without excessive strain. Specific exercises like knee-to-chest stretches, pelvic tilts, child’s pose, and cat-cow stretches can help elongate the spine, strengthen supporting muscles, and improve flexibility, reducing pressure on the facet joints.
Interventional Procedures
When non-invasive treatments do not provide sufficient relief, advanced medical interventions may be considered. These procedures are performed by specialists and target the source of pain directly. Facet joint injections involve the precise delivery of medication into or near the facet joints. These injections often contain a local anesthetic for immediate pain relief and a corticosteroid to reduce inflammation.
Two primary types of facet joint injections exist: intra-articular injections, which deliver medication directly into the joint capsule, and medial branch blocks. Medial branch blocks target the small medial branch nerves that transmit pain signals from the facet joints. They are often used diagnostically; significant temporary relief after the anesthetic indicates facet joint involvement. These injections can provide pain relief lasting weeks to months, allowing patients to participate more effectively in physical therapy.
Radiofrequency ablation (RFA) is a minimally invasive procedure that uses heat to disrupt nerves sending pain signals from the facet joints. After diagnostic nerve blocks confirm the specific nerves, a small hollow needle is inserted near the target nerve, guided by X-ray imaging. Radiofrequency waves generate heat at the needle tip, creating a lesion that prevents pain signal transmission. RFA offers longer-lasting pain relief than injections, potentially lasting one to two years.
When to Seek Medical Advice
While many instances of facet joint pain can be managed with at-home care, professional medical evaluation is sometimes warranted. Consult a healthcare provider if pain persists or worsens despite a few weeks of home treatment. Medical attention is also needed if pain significantly interferes with daily activities or sleep.
New or escalating symptoms should prompt a doctor’s visit. These include radiating pain with numbness, tingling, or weakness in the legs or arms, which could suggest nerve irritation or compression. Urgent medical attention is necessary for “red flag” symptoms such as sudden changes in bowel or bladder control, saddle numbness, or severe pain with fever or unexplained weight loss.