The Facet Joints and the Source of Pain
The facet joints are small joints at the back of each vertebra that link the vertebra above to the one below and work, like a glove, with smooth motion; they guide the spine's rotation and bending and limit excessive movement. With age, repeated strain or loss of disc height, the cartilage in these joints wears down, the joint capsule thickens and becomes inflamed. The resulting pain is a mechanical joint pain, just as in knee or hip arthrosis — felt in the lower back, sometimes radiating to the buttock and back of the thigh, but usually not descending below the knee.
How Is It Distinguished From Disc Pain?
Distinguishing facet pain from disc-herniation pain matters because it determines treatment. Facet-related pain typically increases with prolonged standing, leaning backward and morning stiffness; bending forward and sitting often relieve it. The pain concentrates around the lower back and buttock and rarely descends below the knee. In disc herniation, the pain usually radiates down the leg, below the knee and into the foot, and bending forward and sitting worsen it. This clinical difference is weighed together with examination and MRI; for a definitive distinction, a diagnostic facet injection (temporarily numbing the joint) is sometimes used.
Diagnosis: Examination, Imaging and Diagnostic Block
Diagnosis rests on more than a single test. The examination assesses which movement increases the pain, tenderness on pressure over the facet joints, and the range of low-back motion. MRI and CT show the arthrosis in the joints and other possible causes, but wear seen on imaging does not always mean it is the source of pain. For this reason one of the most reliable diagnostic tools is temporarily numbing the relevant facet joint, or the small nerve supplying it (the medial branch), with a local anaesthetic: if the pain regresses markedly, a facet origin is strongly supported.
Treatment: Mostly Without Surgery
Treatment of facet joint syndrome is stepwise and, in the great majority, does not require surgery. The first step is pain-relieving/anti-inflammatory medication, physiotherapy that strengthens the back and abdominal muscles, and weight control. If these are insufficient, facet joint injections are given under imaging guidance. In recurrent cases that respond well to injection, radiofrequency ablation (silencing the medial-branch nerve with radiofrequency) can provide months of relief. Surgery comes up only when there is an accompanying structural problem such as advanced canal stenosis or spinal instability; for facet pain alone, surgery is rarely needed.
Realistic Expectations and Prevention
Facet joint syndrome is usually a chronic, fluctuating condition; the aim is to manage the pain and preserve quality of life rather than to eliminate it entirely. Methods such as radiofrequency are not a permanent cure but provide relief for a period, and the pain can return when the nerve regenerates, in which case the procedure can be repeated. Regular core exercises, good posture, and avoiding prolonged standing and excessive backward bending are the most effective long-term prevention. The honest picture is this: this joint wear is not reversible, but with the right combination of treatment most patients can lead an active life.