Facet Joint Pain: A Common Cause of Back and Neck Pain
A mechanical joint irritation that often responds well to sensible movement and rehabilitation
Facet joints are the small paired joints at the back of each spinal level, and they play an important role in guiding and controlling spinal movement. When they become irritated, they can cause a very familiar type of back or neck pain — often local, one-sided, and worse with certain movements.
The term facet joint pain can sound technical or worrying, but in most cases it reflects a mechanical joint irritation, not damage or degeneration in the catastrophic sense people often imagine. Much like any other joint in the body, facet joints can become sensitive when they’re overloaded, stiff, or asked to do more than they’re currently prepared for.
This page explains what facet joints are, how facet joint pain typically presents, and what sensible, evidence-led management usually looks like.
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What Are Facet Joints?
Facet joints (also known as zygapophysial joints) are the small paired synovial joints located at the back of the spine. Each spinal level has two facet joints — one on the left and one on the right — linking one vertebra to the next above and below.
Their main roles are to:
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guide and control spinal movement
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limit excessive motion
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share load with discs and surrounding muscles
Before we get too focused on the joints themselves, it’s worth taking a quick step back and reminding ourselves of the spine’s overall layout. If you haven’t already explored it, visit the Spinal Anatomy Explained page for a detailed overview.
We divide the movable spine into three main regions:
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The cervical spine (neck)
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The thoracic spine (mid-back)
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The lumbar spine (lower back)
Each region has its own structure, curve, and movement pattern — and those differences explain why facet joint pain feels slightly different depending on where it occurs.
The joint surfaces have a fine, cartilaginous lining tissue to help with cushioning and provide protection. The size and shape of the individual vertebrae change from being much larger at the bottom, to smaller at the top. This is a consequence of, and indeed a reflection of, the larger forces that are subjected to the vertebrae throughout the lower back in comparison to those at the neck.
Despite this, there is a lower proportion of pain generally attributed to the facet joints in low back pain than in neck pain, and this is thought to be due to the variations in available movement at the vertebra, and also the angle of the joint.
What Is Facet Joint Pain?
Facet joint pain refers to symptoms arising when one or more facet joints become irritated or sensitised. This sensitivity is usually a response to how the joint is being loaded and moved, not a definitive sign of structural damage such as severe degeneration or cartilage loss.
Like joints in other parts of the body, facet joints can become sensitive when:
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The joint is overloaded or repeatedly stressed
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Movement patterns place repeated strain across the joint
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Surrounding muscles are weak or not coordinating effectively
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There has been a sudden change in activity levels or a return to motion after prolonged stiffness
Many people mistakenly think facet pain means “arthritis” or “wear and tear”. While changes in joint surfaces can be seen on imaging with age, these findings do not automatically cause pain and are often present in people without symptoms.
How Does Facet Joint Pain Usually Feel?
Facet joint pain tends to follow a fairly recognisable pattern, although individual experience can vary. Typical features include:
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Localised discomfort, often more noticeable on one side of the spine
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Pain that worsens with extension (leaning backward), rotation (twisting), or side-bending, particularly toward the affected side
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Morning stiffness, or stiffness after prolonged sitting, driving, or inactivity
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Symptoms that ease with gentle movement as the spine “warms up”
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Pain that is not usually associated with classic nerve symptoms, such as marked numbness, tingling, or muscle weakness
What does that look like in real life?
People often describe facet-type pain with phrases like:
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“It’s a deep ache right next to my spine.”
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“It feels sharp when I straighten up or lean back.”
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“Twisting to reach into the back seat / turn in bed sets it off.”
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“I’m stiff when I first get moving, then it eases after a bit.”
Common situations that provoke symptoms include:
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Standing still for a while, especially if posture drifts into an arched lower back
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Walking downhill (because it increases lumbar extension)
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Getting up from sitting, particularly after a long drive
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Rolling in bed, especially when twisting and extending together
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Reaching overhead or lifting with a slight backward lean
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Turning quickly to look behind you, or pivoting while carrying something
This pattern is often quite different from disc-related or nerve-compression pain, which tends to be more strongly linked to bending forward, coughing/sneezing, or sustained sitting — although there can be overlap.
In contrast to nerve compression…
Facet joint pain usually remains local to a specific region of the spine and does not typically produce classic “electric shock” pain that shoots far into the arm or leg, or clear neurological symptoms like progressive weakness.
However, there is an important exception.
The key exception: inflammatory nerve root irritation (why symptoms can spread)
In some cases, inflammation arising from an irritated facet joint can affect nearby nerve roots.
Facet joints sit very close to the spinal nerve roots. When a facet joint becomes irritated, the body’s natural inflammatory response — a necessary part of healing — can involve the release of chemical mediators such as cytokines and prostaglandins. These substances can sensitise nearby nerve tissue, even when there is no physical compression of the nerve.
What might that feel like?
Instead of the classic “pinched nerve” picture, people may report:
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a dull ache spreading into the buttock or upper thigh
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a burning or “raw” feeling that comes and goes
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discomfort that travels only part-way down the leg, often stopping above the knee
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symptoms that worsen when the joint is irritated (for example after a flare), then settle as inflammation calms
A common real-world pattern is:
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the back feels “locked” and sore on one side
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then a day or two later, pain starts to creep into the buttock
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it feels worrying, like sciatica, but there’s no true numbness, no clear weakness, and it doesn’t behave like a classic disc-driven nerve root compression
Why this matters (and why it isn’t automatically “nerve damage”)
This is different from nerve compression due to a disc herniation or spinal stenosis:
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Compression = the nerve is mechanically irritated/trapped, often producing sharp radiating pain, tingling, numbness, and possibly weakness.
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Inflammatory irritation = the nerve is chemically sensitised by nearby inflammation, often producing a more vague ache/burn and heightened sensitivity, without clear neurological loss.
In practice, inflammatory nerve root irritation tends to:
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fluctuate more
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respond well as inflammation settles and movement/load tolerance improves
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improve with sensible rehabilitation rather than aggressive “fixing”
A simple way to think about it
Facet pain is usually a local mechanical joint sensitivity.
But during a flare, the inflammation around the joint can act like a “chemical irritant” to nearby nerves — so symptoms can borrow a nerve-like flavour without being a true pinched nerve.
What Causes Facet Joint Irritation?
Facet joint irritation is almost always multifactorial, meaning that symptoms usually arise from a combination of influences rather than a single structural problem or injury. In most cases, the facet joint itself is not “damaged” in a catastrophic sense; instead, it has become temporarily sensitive because the demands placed upon it exceed what it is currently prepared to tolerate.
Several common contributors often interact:
Reduced spinal movement or prolonged stiffness
Periods of reduced movement — such as prolonged sitting, desk work, driving, or recovery after illness or injury — can lead to stiffness in the spinal joints and surrounding tissues. When movement is limited for long periods, the facet joints are exposed to higher local stresses when activity resumes.
A common example is someone who has been relatively inactive for weeks, then suddenly bends, twists, or straightens more forcefully than the joint is used to. The joint is not weak or damaged, but it is unaccustomed to the load, which can trigger irritation.
Sudden increases in activity
Facet joints are particularly sensitive to changes in workload. Sudden increases in activity — such as returning to the gym, lifting heavier objects than usual, starting a new exercise programme, or increasing walking or running volume — can overload the joint before it has time to adapt.
This is especially true for activities that involve extension and rotation, such as gardening, DIY tasks, lifting and twisting, or sports involving repeated spinal movement. Symptoms often appear after the activity, rather than during it, which can make the cause less obvious.
Poor coordination or weakness of supporting muscles
The facet joints are designed to guide movement, not to absorb excessive force. When the muscles that support spinal movement — including the deep spinal stabilisers, hip muscles, and trunk musculature — are not coordinating effectively, more load is transferred directly to the joints themselves.
This doesn’t mean the muscles are “failing”; it often reflects timing, endurance, or control issues, particularly during fatigue, repetitive tasks, or awkward positions. Over time, this altered load-sharing can make the facet joint more reactive.
Repetitive or awkward postures
Certain postures and movement habits can repeatedly stress specific facet joints. Examples include:
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prolonged standing with an exaggerated arch in the lower back
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sustained leaning or twisting to one side
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repeated reaching or lifting in awkward positions
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working in fixed postures for long periods
These positions don’t cause immediate injury, but over time they can lead to cumulative irritation, particularly if movement variety is limited.
Co-existing spinal changes and altered loading patterns
Changes elsewhere in the spine — such as disc degeneration, reduced disc height, or previous injury — can subtly alter how load is distributed across spinal segments. In these situations, facet joints may take on a greater share of mechanical stress.
Importantly, these changes are extremely common and often painless on their own. They only become relevant when combined with other factors such as stiffness, deconditioning, or increased activity demands.
What this means in practical terms
None of these factors automatically mean the joint is “broken”, deteriorating, or beyond recovery. Instead, they describe a situation where the joint’s tolerance has been temporarily exceeded.
Facet joint irritation is best understood as a capacity issue:
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the joint can handle load
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the joint can handle movement
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but not yet at the volume, speed, or frequency being asked of it
With appropriate management — improving movement, restoring strength and coordination, and gradually rebuilding load tolerance — most facet joint irritation settles well.
Are Facet Joints Affected By Ageing?
Yes — facet joints change with age, just like other joints in the body such as the hips, knees, or shoulders. These changes are a normal part of ageing and reflect how the spine adapts over time, not evidence that something has “gone wrong”.
With increasing age, facet joint surfaces may become less smooth, the joint capsule may stiffen, and small bony changes can develop. These findings are extremely common on imaging, even in people who have never experienced back or neck pain.
Importantly, large studies consistently show that facet joint changes seen on scans do not reliably predict pain. Many people with significant imaging changes have no symptoms, while others with very little visible change experience pain.
For this reason, age-related facet joint changes are best viewed as background context, not a diagnosis. They describe how long the joint has existed, not how well it is currently functioning or how sensitive it is.
How Is Facet Joint Pain Diagnosed?
Facet joint pain is diagnosed primarily through clinical assessment, not imaging alone.
Diagnosis focuses on:
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the pattern and location of pain
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how symptoms respond to specific movements (particularly extension, rotation, and side-bending)
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how pain behaves over time and with activity
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physical examination findings
Scans such as MRI or CT may show facet joint changes, but because these findings are common in people without pain, imaging cannot confirm facet joint pain on its own.
Imaging is most useful when:
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symptoms are severe, unusual, or worsening
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pain does not follow a typical mechanical pattern
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there are signs that suggest a more serious cause
In some specialist settings, diagnostic injections may be used to temporarily numb the nerves supplying a facet joint. These are not routinely required and are usually considered only when symptoms are persistent and unclear after thorough assessment.
What Usually Helps Facet Joint Pain?
Most facet joint pain responds well to conservative, evidence-led management focused on restoring movement and load tolerance rather than “fixing” the joint.
Key components typically include:
Restoring movement
Gentle, regular spinal movement helps reduce stiffness, improve joint nutrition, and reduce protective muscle guarding. Complete rest often worsens symptoms.
Improving strength and control
Strengthening and coordinating the muscles that support spinal movement allows load to be shared more effectively, reducing stress on the facet joints themselves.
Gradually rebuilding tolerance
Facet joints often become sensitive after changes in activity. Management focuses on gradually increasing what the joint can tolerate, rather than avoiding movement altogether.
Understanding the condition
Clear explanation and reassurance reduce fear-driven muscle tension and unnecessary activity restriction, both of which can perpetuate symptoms.
Physiotherapy typically guides this process, tailoring rehabilitation to the individual rather than applying generic exercises or rigid posture rules.
Do Injections Or Procedures Help?
In some cases, facet joint injections or nerve-targeting procedures may be considered, particularly when pain remains persistent despite appropriate rehabilitation.
Most commonly, these take the form of medial branch blocks. These injections are usually used diagnostically rather than therapeutically. A small amount of local anaesthetic is injected around the medial branch nerves that supply sensation to the facet joints. If pain reduces significantly for a short period, this helps confirm that the facet joints are a meaningful contributor to the symptoms.
It’s important to understand that medial branch blocks are not intended as a long-term solution. Their main value lies in clarifying the source of pain and, when relief is achieved, creating a window of opportunity to progress rehabilitation. Ideally, this period of reduced pain should be followed up promptly with physiotherapy to restore movement, strength, and load tolerance while symptoms are calmer.
In practice, this can be challenging — particularly within NHS pathways — where delays between injections and physiotherapy appointments may limit how effectively this window is used.
If medial branch blocks provide clear but temporary relief, some people may be offered radiofrequency denervation (also known as radiofrequency ablation). This procedure targets the same medial branch nerves with the aim of reducing pain for a longer period.
Denervation can be helpful for selected individuals, but several important points are worth understanding:
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Denervation does not address ageing or structural joint changes
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Pain relief is not permanent — the medial branch nerves are part of the peripheral nervous system and can regrow over time
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When nerves regenerate, symptoms may gradually return
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Repeated denervation procedures do not always produce the same level of benefit as the first, due to the complex way the nervous system and pain processing adapt over time
For this reason, denervation is best viewed as a symptom-modifying tool, not a cure. When used, it tends to be most effective when combined with rehabilitation rather than used in isolation.
Key points to understand:
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injections do not reverse ageing or structural change
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medial branch blocks are primarily diagnostic
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any pain relief is usually temporary
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procedures work best when paired with physiotherapy
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repeated procedures may have diminishing returns
For most people, injections and procedures are not necessary, and many recover well through conservative, evidence-led management alone.
When Should You Seek Further Medical Advice?
Facet joint pain is rarely serious, but further medical assessment is important if:
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pain is severe or progressively worsening
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symptoms do not improve as expected
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pain follows significant trauma
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neurological symptoms develop (such as progressive weakness, significant numbness, or changes in bowel or bladder function)
These features are uncommon but require prompt investigation to exclude other causes.
The Key Message
Facet joint pain is common, mechanical, and rarely dangerous.
It does not usually indicate serious damage, and imaging findings often overstate the problem rather than explain it. Most cases respond well to sensible, progressive management focused on movement, strength, and understanding what is happening.
Knowing what facet joint pain is — and just as importantly, what it isn’t — allows for better decisions, better movement, and a more confident recovery.
Frequently Asked Questions about Facet Joint Pain
1) What is facet joint pain?
Facet joint pain comes from irritation of the small joints at the back of the spine that help guide movement. It’s usually a mechanical problem, meaning the joint isn’t tolerating current loads or movements well, rather than being damaged or “worn out”.
2) Is facet joint pain serious?
Facet joint pain is rarely serious. Although it can be uncomfortable and limiting, it usually reflects a temporary joint irritation rather than a dangerous spinal problem. Most cases improve with sensible movement and rehabilitation.
3) What does facet joint pain feel like?
Facet joint pain is often:
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local and one-sided
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worse with leaning back, twisting, or side-bending
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stiff after rest or first thing in the morning
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eased by gentle movement
It usually does not cause significant numbness, tingling, or weakness in the arms or legs.
4) What causes facet joint irritation?
Facet joints can become irritated due to a combination of factors, including stiffness, sudden changes in activity, reduced strength, prolonged postures, or repeated loading. Age-related joint changes can play a role, but they don’t automatically cause pain.
5) Is facet joint pain the same as arthritis?
Not exactly. While facet joints can develop arthritic changes over time, many people with arthritis on scans have no pain. Facet joint pain is more about how the joint is behaving and being loaded than what it looks like on imaging.
6) How is facet joint pain diagnosed?
Facet joint pain is mainly diagnosed through clinical assessment, looking at symptom patterns and how pain responds to movement and position. Scans may show facet joint changes, but these are common and don’t reliably confirm the source of pain on their own.
7) Can physiotherapy help facet joint pain?
Yes. Physiotherapy often focuses on restoring movement, improving strength and control, and gradually increasing tolerance to activity. The aim isn’t to “fix” the joint, but to help it cope better with everyday demands.
8) Should I rest if I have facet joint pain?
Complete rest is usually not helpful. While short-term modification of painful activities can be useful, gentle movement is often key to reducing stiffness and sensitivity and supporting recovery.
9) Do facet joint injections work?
Facet joint injections or nerve-targeting procedures may help some people with persistent pain, but results vary. They’re generally considered supportive treatments, most effective when combined with movement-based rehabilitation rather than used alone.
10) How long does facet joint pain take to settle?
Many facet joint flare-ups improve within days to weeks. Some people experience recurring episodes, often linked to changes in activity or prolonged stiffness. With appropriate management, most people return to normal activity without long-term problems.
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