Understanding Arthritis of the Small Spinal Joints
Facet joints are small paired joints located at the back of each spinal level that allow your back to bend and twist. Like any joint, they can develop arthritis and become a source of pain. Lumbar facet joint pain is one of the most common causes of chronic low back pain, and it's very treatable once identified.
Causes
Facet joint pain typically develops from:
Degenerative changes (osteoarthritis) of the facet joints over time.
Repetitive extension or twisting movements that stress the joints.
Prior back injury.
Poor posture and excess body weight, which increase joint stress.
Normal aging of the spine.
Symptoms
Typical symptoms include:
Localized low back pain, often on one or both sides of the spine.
Pain that worsens with bending backward (extension) or twisting, and improves with bending forward or sitting.
Pain that may radiate into the buttock or upper thigh, but typically not below the knee.
Morning stiffness that improves somewhat with movement.
Seek prompt medical care if: You develop new loss of bladder or bowel control, numbness in the groin or inner thighs, or rapidly worsening leg weakness. Also seek prompt care for back pain with fever, unexplained weight loss, a history of cancer, or after significant trauma.
Imaging Studies to Consider
Imaging and diagnostic injections together confirm facet joints as the pain source:
MRI or CT of the lumbar spine shows facet joint arthritis and hypertrophy (enlargement).
X-ray, including oblique views, can also show facet joint changes.
Diagnostic medial branch block is a targeted injection of numbing medication near the small nerves supplying the facet joint; significant, though temporary, pain relief confirms the diagnosis and is considered the gold standard test.
Physical Therapy, Home Exercise & Other Conservative Techniques
Non-invasive treatments are typically tried first and often provide significant relief:
Physical Therapy
Extension-based exercises to reduce load on the facet joints.
Core stabilization training.
Manual therapy for the lumbar spine.
Home Exercise Program
Core stabilization exercises.
Flexibility exercises for the low back and hips.
Posture training.
Other Studied Techniques
Heat to ease muscle tension around the joints.
Activity modification during flares.
Interventional Treatment Options
Facet joint pain responds well to targeted, non-opioid interventional treatments:
Medial branch block: A diagnostic injection near the small sensory nerves supplying the facet joint; also provides temporary pain relief.
Intra-articular facet joint injection: Steroid medication injected directly into the joint to reduce inflammation.
Radiofrequency ablation (RFA) of the medial branches: For patients who get good relief from diagnostic blocks, RFA uses heat to disable these nerves for longer-lasting relief, often 6-12 months or more.
Acupuncture: A technique that may provide additional relief for chronic low back pain alongside facet-directed treatments.
Platelet-rich plasma (PRP) injection: For facet joint pain confirmed by diagnostic blocks, PRP injected into the joints under x-ray guidance is one of the better-supported spine uses of PRP.
Neuromodulation: Spinal Cord & Peripheral Nerve Stimulation
For chronic axial low back pain that isn't fully addressed by RFA, or that involves multiple pain generators, neuromodulation is an option:
Spinal cord stimulation (SCS): Considered for widespread, chronic low back pain that persists despite facet-directed treatments, particularly when combined with other sources of pain.
How Strong Is the Evidence?
A summary of the evidence supporting key treatments for lumbar facet joint pain:
How to read this: Strong means consistent results from multiple high-quality studies. Moderate means generally favorable results with some limitations. Mixed or early means results so far are inconsistent or still emerging. Limited means few or lower-quality studies; these options can still be considered in select cases following a discussion with your healthcare provider.
Diagnostic medial branch block: Strong evidence.
Radiofrequency ablation: Moderate evidence.
Intra-articular facet injection: Mixed or early evidence.
Acupuncture (adjunctive): Moderate evidence.
Platelet-rich plasma (PRP): Strong evidence.
Evidence reviewed November 2026. These ratings summarize published research and major medical society guidelines available at that time. Research continues to evolve, and we will go over the most current evidence for your situation at your visit.
Pain Psychology Techniques
Pain psychology techniques support long-term management of chronic facet joint pain:
Cognitive behavioral therapy (CBT) for pain helps manage chronic pain's impact on daily function.
Graded activity pacing encourages safe movement without provoking flare-ups.
Relaxation training and diaphragmatic breathing.
Mindfulness-based stress reduction.
Non-Opioid Medication Options
Non-opioid medications can help manage facet joint pain:
Anti-inflammatory and analgesic options
NSAIDs like ibuprofen, naproxen, or meloxicam reduce joint inflammation.
Acetaminophen for additional pain relief.
For associated muscle tightness or chronic pain
Muscle relaxants (short-term) for associated muscle spasm.
Duloxetine is an SNRI antidepressant also approved for chronic musculoskeletal pain.
Topical treatments
Lidocaine patches or topical NSAID gel is applied directly over the painful area.
Related Procedures
Related Conditions
Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
