Facet joint back pain

What it is

Each pair of vertebrae is connected at the back by two small facet joints. They guide movement and carry a share of the load, and that share rises substantially when the spine extends - arching backward, standing for long periods, or lying face down.

They degenerate like any other joint and become a genuine pain source. The characteristic pattern is the opposite of disc pain: worse with extension and rotation, better with flexion, worse standing and walking, better sitting - though in practice the two frequently coexist.

What it feels like

• Low back pain, often to one side, sometimes referring into the buttock
• Worse arching backward, twisting and standing for long periods
• Better sitting and bending forward
• Stiff in the morning and after being still, easing with movement
• Rarely refers below the knee, which distinguishes it from nerve pain

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Degenerative change in the facet joints

The joint surfaces roughen, the capsule thickens and the joint enlarges, exactly as in any other arthritic joint. It becomes a genuine pain source with its own nerve supply.

Extension loading

The facet joints carry a small share of load in neutral and a much larger share in extension. Arching, standing and reaching overhead all load them directly.

Disc height loss

As discs lose height the facet joints are pushed closer together and carry more load. Facet and disc degeneration are coupled processes rather than separate ones.

An anteriorly tilted pelvis and tight hip flexors

Both increase the resting lumbar arch, which means the facets are loaded more throughout the day rather than only during deliberate extension.

Weak deep trunk musculature

Without muscular control the segment moves further into extension under load and the joints take more of it.

Occupational and sporting extension

Overhead work, gymnastics, dance, cricket bowling and any repeated arching load these joints far more than ordinary activity.

Age

Facet arthritis becomes very common from middle age onward. As elsewhere in the spine, its presence on imaging correlates weakly with symptoms.

Body weight

Extra abdominal weight increases the lumbar arch and the load through the facets.

Prolonged standing

Standing still loads the facets continuously with no variation, which is why it is often the most provocative everyday activity.

Who tends to get it

• Adults over forty, in whom facet degeneration becomes common
• Anyone whose work involves overhead reaching or repeated arching
• Gymnasts, dancers, cricket bowlers and other extension athletes
• People with tight hip flexors and an increased lumbar arch
• Anyone with existing disc height loss

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineBack Pain/Bulletproofing

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Same red flags as low back pain; inflammatory pattern in a young adult - screen for axial spondyloarthritis

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Symptoms typically fluctuate over years rather than progressing steadily, and most people manage well with strengthening, hip mobility and activity modification. Improvement over six to twelve weeks is a reasonable expectation. Medial branch blocks and radiofrequency denervation are options for persistent, well-localised facet pain, and they work best where the diagnosis has been confirmed by a diagnostic block rather than assumed from imaging.

Prevalence basis: Diagnostic block studies

Others the same routine covers

These share the Back Pain/Bulletproofing routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.