The spine’s movement is facilitated by small, paired joints located at the back of each vertebra called facet joints. These joints provide both stability and controlled flexibility, allowing the spine to bend, twist, and extend. Facet joint pain, often called facet joint syndrome, typically arises when the cartilage wears down or the joint capsule becomes inflamed. This mechanical pain often worsens with movements that compress the joint, such as leaning backward (extension) or twisting the torso. Treatment follows a progressive path, starting with simple strategies and moving toward advanced procedures if pain persists.
Conservative Home Management
The initial approach to managing facet joint discomfort involves simple steps performed at home. Over-the-counter medications are the first line of defense against pain and inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, reduce inflammatory chemicals, while acetaminophen provides pain relief without addressing inflammation.
Temperature therapy offers a drug-free way to manage flare-ups. Applying cold packs reduces acute inflammation and swelling. Once acute inflammation subsides (typically within 48 to 72 hours), switching to heat therapy increases blood flow, promoting relaxation and easing muscle spasms.
Patients should also focus on activity modification to avoid movements that exacerbate the pain. Since facet pain is aggravated by extension, twisting, and prolonged sitting, maintaining gentle movement and adjusting posture are helpful. Avoiding hyperextension and excessive twisting prevents further joint irritation, and light activity, such as walking, prevents stiffness.
Physical Rehabilitation and Prescribed Medications
When home care measures are insufficient, a structured approach involving physical therapy (PT) and prescription medications is introduced. PT is important for achieving long-term functional recovery and stability. The primary goal of PT is to strengthen the core and stabilizing muscles, reducing mechanical stress on the facet joints.
Therapists guide patients through exercises to improve posture and increase flexibility without provoking pain. Techniques include gentle lumbar flexion exercises, such as the knee-to-chest stretch, which temporarily relieves pressure. Manual therapy, using hands-on techniques like joint mobilization, can also improve the range of motion in affected joints.
A doctor may prescribe stronger medications for pain unresponsive to over-the-counter options. These include prescription-strength NSAIDs for potent anti-inflammatory effects, and muscle relaxants, such as cyclobenzaprine, to control painful muscle spasms. A short course of oral steroids may also be prescribed to quickly reduce severe, acute inflammation.
Targeted Injection Therapies
If the pain persists despite conservative management, targeted injection therapies are used to confirm the pain source and provide temporary relief. These procedures are typically performed under fluoroscopic guidance, which uses continuous X-ray imaging to ensure precise needle placement. This image guidance maximizes the effectiveness and safety of the injection.
Medial Branch Blocks (MBB)
MBBs are primarily diagnostic procedures used to pinpoint the exact source of pain. The medial branch nerves transmit pain signals specifically from the facet joints. A local anesthetic is injected near these nerves, and if the patient experiences significant, temporary pain relief, it confirms that the facet joint is the generator of the pain. This diagnostic block is a precursor to longer-lasting interventions.
Facet Joint Injections
Facet Joint Injections, also known as intra-articular injections, involve injecting a mixture of a long-acting corticosteroid and an anesthetic directly into the facet joint capsule. This procedure is intended to be both diagnostic and therapeutic. The anesthetic provides immediate, temporary relief, while the corticosteroid works over several days to reduce inflammation within the joint, with relief that can last from weeks to several months.
Advanced and Minimally Invasive Interventions
For patients experiencing chronic, persistent pain that returns after the temporary relief of diagnostic blocks and steroid injections, more advanced, minimally invasive interventions are considered.
Radiofrequency Ablation (RFA)
RFA is the most common long-term procedure following a successful medial branch block. This technique uses radiofrequency energy to generate heat, creating a lesion on the medial branch nerves. This prevents the nerves from transmitting pain signals from the facet joint to the brain. Although the nerves eventually regenerate, RFA provides significant pain relief that typically lasts between six and twelve months. RFA is a low-risk, outpatient procedure that targets the pain pathway.
Spinal Fusion
Spinal fusion is a surgical intervention reserved for chronic facet joint pain that has failed to respond to all other conservative care and injection therapies. This procedure permanently joins the painful vertebrae together to eliminate motion at the affected facet joint. Fusion is typically considered only when there is documented evidence of severe instability or concurrent nerve compression, due to its prolonged recovery period.