Overview

The facet joints (zygapophyseal joints) are the paired small joints at the back of each spinal segment. They guide bending and twisting of the spine, limit rotation, and help prevent the vertebrae from slipping forward over each other.

These joints can become a source of pain — usually described as facet joint disease, arthropathy or syndrome — and are a common cause of chronic lower back pain, estimated to contribute in 15–41% of people with chronic low back pain.

Typical Pattern

Aching in the lower back close to the spine, often on one side
Worse with leaning back (extension), twisting, or getting out of a chair
Stiffness after prolonged sitting or inactivity, with pain on the first movements
Pain that can spread into the buttock or back of the thigh but rarely below the knee
No leg numbness or weakness (when those appear, the pattern is different)

Why It Develops

Facet joints are load-bearing joints: with age, repeated extension and rotation loading, or previous injury, the cartilage can wear and the joint can become irritated. This is common in older backs, but active younger people with lots of extension and twisting — weightlifting, gymnastics, golf — can develop it too.

Imaging often shows "wear and tear" changes in facet joints after middle age, and those changes alone do not prove the joint is the pain source. Many people with similar scans have no pain.

How It Is Diagnosed

A clinician diagnoses facet joint pain mainly from the pattern:

Pain reproduced by leaning back, rotating or side-bending (for example, Kemp's test)
Relief with forward bending in some people
A normal neurological examination

Imaging helps exclude fracture, disc herniation or other causes. If conservative care fails and the diagnosis remains uncertain, small diagnostic nerve blocks (medial branch blocks) can test whether a specific facet joint is the source, and a positive block may open the door to further options.

Treatment

Conservative care is the first line:

Education and reassurance about what the pattern means
Activity pacing, including breaking up prolonged sitting
Exercises for mobility, core control and hip and glute strength
Manual therapy in some cases

When pain persists despite a good conservative trial, image-guided injections or radiofrequency treatment of the nerves to the joint are considered. These are used to support, not replace, an exercise-based plan. Surgery is rarely needed for facet joint pain alone.

When to Get Assessed

See a clinician if pain is persistent, limits work or sport, or keeps returning. Urgent assessment is needed if back pain comes with new leg weakness or numbness, bladder or bowel changes, saddle numbness, fever, unexplained weight loss, or severe pain after major trauma.

References

StatPearls. "Lumbar Facet Arthropathy." https://pubmed.ncbi.nlm.nih.gov/30855816/
StatPearls. "Facet Joint Disease." https://pubmed.ncbi.nlm.nih.gov/31082093/

This information is for education only and is not a medical diagnosis. InjuryAtlas does not replace an assessment by a qualified health professional. If you have severe pain, visible deformity, numbness, loss of function, or symptoms that are getting worse, seek medical care promptly.

Lumbar Facet Joint Pain