Facet Joint Pain of the Low Back – Symptoms and Treatment

/ Thomas Cohn, MD

facet low back painLow back pain can have many causes.  Structures in the lumbar region include:

  • Muscles
  • Bones
  • Joints
  • Discs
  • Nerves
  • Pelvic organs

Sensory feedback from these structures can be similar. As a result, determining the cause of low back pain often becomes more complex since multiple areas can produce sensory signals that are perceived the same way.  Furthermore, there are often multiple structures contributing to the pain perceptions we have and it may be necessary to treat multiple pain generators to control symptoms.

The facet joints in the spine are small joints the size of our finger joints that articulate on both sides of the spine, posteriorly, between vertebral bodies at every level.  They have significant mobility and carry the full body weight. Bending backwards closes the joint, while bending forward tends to open the joint.  Since they have the same size and mobility as the finger joints, we can see the same wear and tear type changes in the hands, and assume fairly accurately that the same changes will be present in the low back facet joints.

Symptoms of Facet Joint Pain

The symptoms related to facet joint pain are similar to pain from other joints:

  • Stiffness after sitting or lying in one position
  • Pain often with extension of the spine backwards

Pain from facets is often just along the spine and does not radiate significantly into the legs.  Often, the lumbar muscles are very tight, trying to prevent excessive spine movement.  Severely degenerated facets have significant bony overgrowth, and then can narrow the exit of spinal nerves and cause radiating pain into the leg.

The diagnosis of facet pain is made by:

  • Patient history
  • Physical exam
  • Radiologic imaging
  • Nerve blocks to the joints

The typical history of facet joint problems is pain along the spine without significant radiation. X-rays and CT scans often show facet problems in detail, but pain can be present even with normal radiologic studies.  Diagnostic medial branch blocks are the most reliable tool to establish the etiology of pain from facet joints, and two nerves provide the sensory feedback from each joint.

Treatment

Treatment of facet joint pain must be multifaceted to be successful.  Basic level management includes stretching and core strengthening of the lumbar region, with using good body mechanics.  Nonsteroidal anti-inflammatory drugs like naproxen and aspirin often are very helpful.  More advanced physical therapy including a TENs unit for electrical stimulation and traction of spine is sometimes helpful in addition to the above.  For persistent symptoms, facet joint steroid injections and medial branch blocks with radiofrequency denervation of the joint can be extremely beneficial.