Facet joint syndrome is just like arthritis condition of the spine which can be a significant source of neck as well as back pain. When the degenerative changes occur between the spine bones, then this syndrome is caused. The cartilage which is inside the facet joint can start breaking down and will become inflamed, which can trigger pain signals in nearby nerve endings. Such symptoms can be managed by medication, physical therapy, joint injections, nerve blocks, and nerve ablations. If the chronic symptoms appear, then they will need surgery to fuse the joint.
Two or more bones in your body are connected by a joint and then they function to promote motion. The joint which connects each of your vertebrae are called facet joints. Some other names of facet joints are zygapophyseal or apophyseal joints, or your doctor can directly refer to them as simply facets.
Just like any other joint in your body, the job of every facet joint is to promote healthy movement, along with the intervertebral disc providing motion segment stability. The disc will start functioning as a spacer, supports motion between the vertebral bodies. It will form a tripod relationship between the intervertebral disc and the facet joint. Degeneration or damage to one affects the other.
Facet joints can be damaged by the effects of aging or traumatic injury. This is the leading cause of back pain called as facet joint syndrome.
Facet joint anatomy
Your neck and back bends forward and backward because of cervical, thoracic and lumbar facet joints. They are the common source of spine-related pain. The facet joints which are situated in your low back turn out to be most susceptible to facet joint syndrome. This is because most of the pain and strain is endured by the lumbar spine. But chronic pain can also be caused by the facet joints which are situated in your cervical (neck) and thoracic (midback) spine.
Common Cause of Low Back Pain
Amongst the most common medical complaints worldwide is the low back pain and the common cause of low back pain is the facet joint syndrome. Lumbar spine is the most common sites of facet joint pain at the L4-L5 level followed by L5-S1. Many a times the facet joint syndrome affects the lumbar spine; the cervical and thoracic spinal regions might also get affected.
The neck is the second most common location of the facet joint syndrome after the low back. It has a prevalence ranging from 30% to 70% of neck pain cases. Motion is very limited because of the articulations (movement) of the ribs with the vertebral body. Talking about the neck, the facet joint syndrome mostly occurs at the C4-C5 level.
The least likely region of the spine to be affected by the facet joint syndrome is the thoracic spine or midback. For the mid back pain cases, the prevalence of facet pain ranges between 33% and 48%.
What are the symptoms?
The degeneration of the facet joint can be painless unless and until an event will trigger symptoms. There are many symptoms which indicate a person’s pain is coming from the facet joints. The pain is many a times a diffuse, dull ache is the low back directly over the spine which can spread to the buttocks. In the neck it can be felt in the shoulders and the back of the skull.
Pain is caused by the movements like bending backwards or twisting sideways towards the affected joint. Pain might get worse by standing or periods of inactivity. The best way to ease the pain is by engaging in activities which take the weight off the joint like sitting, leaning forward, or changing positions. Facet joint symptoms may also mimic the pain of a disc herniation. If there is a formation of bone spurs and they press on the spinal nerves, then the pain might be felt down the arms or legs. The pain might be chronic or it can come in periodic flare-ups.
What are the causes?
When we start getting older, the cartilage in our joints starts to wear down. An injury, repetitive movements, obesity, poor posture and other spine conditions which change the way the facet joints align and move can cause pain.
The changes in the facet joints can start occurring with the deterioration of a vertebral disc. Now when the load of the body weight will start shifting to the facet joint, the cartilage will start breaking down, the joint space narrows, and the bones rub together.
Who is affected?
Facet joint syndrome occurs in both men as well as women. It is very common in between the ages of 40 and 70 and in those who are prone to arthritis. It might start developing in people who had spine injury.
How Facet Joint Syndrome is Diagnosed
If you want to achieve a perfect diagnosis, then it is important to see a physician who has great knowledge in spinal disorders like an orthopaedic surgeon, physiatrist, or pain management specialist.
When you will meet your doctor, he or she will review the medical history and then perform a physical as well as neurological exam. A physical exam involves certain “tests” or physical maneuvers intended to recreate your pain. These might include bending, twisting as well as walking.
The classic finding on exam is the direct pain over the facet joints (low back) with extension. The neurological aspect of your evaluation will consider your nervous system and might involve testing your reflexes and other responses.
While the medical history as well as physical/neurological exam will help in ruling out the possibility of other conditions, a diagnostic block or injection is important for confirming facet joint syndrome. There are different types of diagnostic injections like image-guided medial branch blocks as well as intraarticular injections of local anesthetic.
The work of diagnostic injections is to send local anesthetic or anti-inflammatory medication to the site of suspected joint pain. If there is decrease in your pain and mobility is restored immediately or shortly after the injection, then there is an indication that your doctor has located the source of your pain and then you can proceed with a targeted treatment plan so that it can be addressed.
What treatments are available?
The facet joint arthritis cannot be reversed, but there is evidence that exercise, lifestyle changes and careful management of your back pain can contribute to better quality of life. If you are not able to manage and control your pain with the help of conservative therapies, then your doctor may recommend injections, ablations or surgery.
Self care: To prevent painful episodes, use correct posture and keep your spine in alignment. Make adjustments to your daily standing, sitting, as well as sleeping habits. The load on the facet joints can be reduced by losing weight and then it can alleviate pain.
Medications: There are some patients which may need oral anti-inflammatory medications or topical patches, creams, salves or mechanical bracing. For muscle spasms, muscle relaxants are occasionally prescribed.
Physical therapy and Chiropractic: Exercise proves to be helpful for a painful facet joint as it can help you heal faster. You can get proper instructions by physical therapists on proper lifting and walking techniques. They will work with you to strengthen and will help in stretching your lower back, leg, and stomach muscles. It is your responsibility to follow the strengthening and stretching exercises which your physical therapist may show you. Chiropractic can also be used with great success for treatment of facet syndrome. During chiropractic adjustments improve range of motion and reduction of pain is achieved. Chiropractors are trained to locate and alleviate facet issues.
Below you can see a short video of our physiotherapy treatment available in both of our clinics in Toronto (Scarborough) and Vaughn (Woodbridge). We often combine an advanced modalities/machines for this type of condition. In this video you can see the use of Tecar – Radio Frequency, shockwave and laser treatment with specialized exercises at our clinic in both Toronto and Vaughan. This patient which is suffering from acute back pain is a facet syndrome patient.
Are you looking for physiotherapy or a Chiropractor? If Yes, then visit Simply Align Rehab Physio in Scarborough/Toronto or Woodbridge/Vaughan or you can always call or text us for your Physiotherapy or Chiropractor needs in Toronto at (416) 438-3230 or For Physiotherapy or Chiropractor need in Vaughan (Woodbridge) at (905) 638-9840.