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What is Facet Joint Syndrome?

Published September 27, 2018
| Written By SpineNation Editorial Staff   | Medically Reviewed by Jerry Nichols, MD

Anyone suffering from facet joint syndrome can attest to how it disrupts everyday life. People with this condition find simple things like getting through work, spending time playing with children or grandchildren, or restful sleeping difficult. A form of osteoarthritis, facet joint syndrome may be caused by aging, injury, or pressure on the facet joints.

What are facet joints?

Facet joints are small joints that allow you to bend and twist from the spine. Each pair of vertebrae has two facet joints. When your spine is healthy, smooth cartilage and lubricating fluids cushion your facet joints. This keeps them moving across one another effortlessly.

According to Jerry Nichols, MD, a physical medicine and rehabilitation (PM&R) physician and faculty member at Virginia Tech Carilion School of Medicine, “Healthy facet joints are easy to take for granted until you start having pain. Our spines are constantly in motion. From the moment we first sit up in bed, our facet joints play a key role in almost everything we do.”


People with facet joint syndrome feel pain and stiffness that makes standing up straight or getting themselves up from a chair difficult. Symptoms may include:

  • Inflammation
  • Tenderness
  • Stiffness
  • Difficulty performing daily activities requiring back and core support
  • Lower back pain that travels into the buttocks or thigh
  • Pain radiating through the back of the neck and into the shoulders
  • Decreased flexibility and limited motion
  • Muscle spasms

Locations of facet joint pain

  • Cervical facet joint pain can be felt in the areas of the base of the skull, upper back and shoulders, mid-back or neck. Some patients may present with frequent headaches or even ringing in the ears.
  • Thoracic facet syndrome, which involves the mid-back, is less common than cervical and lumbar facet syndrome. This is likely because the thoracic spine is less mobile, which means less likelihood of aggravating the thoracic facet joints.
  • The lumbar spine has considerable motion and high compressive forces. Facet pain from these joints is quite common. Pain is usually felt directly over the affected joints, but may also be felt in the buttocks, hips, groin, and back of the thighs depending on which facet joint is injured.

How they become damaged

The primary causes are facet joint damage, cartilage loss from wear and tear on the joint, and disc degeneration. Facet joints are protected by cartilage and lubricating fluids that allows smooth movement between vertebrae. As cartilage is lost and the worn joint produces less lubricating fluid, joint motion becomes more painful as it develops a "bone-on-bone" appearance.

When caused by disc degeneration from worn and collapsing discs, narrowing between each vertebra affects facet joint alignment and causes joint damage. The added pressure to the surface of the vertebrae leads to cartilage loss.

External factors for facet joint injuries are poor sleeping positions, overuse from heavy lifting, damage from playing sports, or from car accidents. For some people, arthritis can create pain in the facet joints causing them to become inflamed. People living with facet joint syndrome can find it difficult to walk or conduct their daily activities.

Determining if you have facet joint syndrome

With facet joint syndrome symptoms can mirror those of a herniated disc. Your doctor can confirm a facet joint syndrome diagnosis by injecting an anesthetic and an anti-inflammatory in the joint. X-ray fluoroscopy is used to ensure the injection is accurately placed into your facet joint. Fluoroscopy is a form of medical imaging showing a streaming X-ray image on a monitor in real-time. During a fluoroscopic procedure a special dye is injected before any medication is administered. The dye is visible under x-ray, and helps ensure the injection is placed accurately. Once the injection is completed, your pain will be monitored within 20 to 30 minutes post-injection and over the course of the week. If your pain levels drop significantly after the treatment, you have facet joint syndrome. If your pain is unchanged, your facet joint may not be the source of your back pain.

“Facet joint injections are considered to be minimally invasive,” notes Nichols. “In experienced hands, it should not be any more invasive than an injection into any other joint. Because your doctor uses X-ray to guide the needle, you can also be sure that only the intended structures will be injected. The injection itself typically only takes a few minutes, though you will have to arrive early and then be observed after the procedure for a while. All in all, this can take up an hour or two of your day.”

Potential Treatments

There are many options for managing facet joint pain—both non-surgical and surgical. Your doctor may begin with conservative treatments designed to aid with spinal flexibility and relieve pain. Sometimes treating facet joint syndrome can involve physical therapy and exercise. Therapy can sometimes intensify the pain before improving it, and your doctor may prescribe anti-inflammatory medications and pain relievers to help you manage. Depending on the severity of your condition, facet joint injections may be used to treat your condition. While non-surgical options offer temporary relief, if facet joint pain persists and becomes chronic, surgery may be necessary to eliminate pain.


If you’re like most patients, you should feel better following these procedures. Your doctor will clear you to return to work or daily activities. Nichols' advice? "Recovery after these procedures can take a little time. Listen to your body. You're better off easing back into light activity first, and checking with your doctor before moving on to more strenuous exercise or activity," he says.

Updated: November 10, 2019

Contributors and Experts

Jerry Nichols, MD is board certified in Physical Medicine and Rehabilitation with Carilion Clinic.