Overview of Facet Joints and Facet Joint Pain

The facet joints are located between neighboring vertebrae, behind the vertebral bodies. They help stabilize the spine, helping prevent the vertebra from slipping forward and also keeping the spine from twisting too far or extending back too much.

The facet joints help control spine movements such as:

• Flexion
• Extension
• Lateral flexion
• Hyperextension
• Twisting and rotation

Individual vertebrae are connected to one another by intervertebral discs, and pairs of facet joints—two above and two below. Sometimes facet joints are referred to as the zygapophysial joints.

Each facet joint is comprised of:

• An inferior articular process: A downward bony projection that comes from the vertebra above
• A superior articular process: An upward bony projection that comes from the vertebra below

The flat surfaces of these processes touch and glide against one another. With the help of ligaments, the 24 individual spinal bones connect together to make a column.

The facet joints in different areas of the spine are shaped, sized, and oriented differently. These differences contribute to varying flexibility in different areas of the spine.

• Facet joints in the cervical spine (neck) are adapted for a range of movements.
• In the thoracic spine (upper and mid-back) facets are angled to facilitate limited rotation, turning, and twisting.
• In the lumbar area (lower back), the facet joints face each other, limiting your ability to rotate and twist your low back.

The facet joint is a synovial joint, which means that it’s enclosed by a capsule made of connective tissue. The capsules of the facet joints are aptly named facet joint capsules.

Damage to facet joints is a common reason for chronic spine pain. Common problems that cause facet joint pain include osteoarthritis and whiplash.

Facet Joint Hypertrophy and Arthritis

The bones of the facets are normally lined with cartilage, which cushions the joint. With osteoarthritis of the spine, the cartilage may wear out, resulting in bone-on-bone articulation at the facet joint.

Osteoarthritis and/or degenerative disc disease are wear-and-tear conditions that may lead to the formation of osteophytes (bone spurs) and/or facet joint hypertrophy (enlarging and swelling of the facet joint).

As these degenerative changes in the spine progress, the space in the spinal canal and/or neural foramen may develop stenosis (become narrow).

• Narrowing of your spinal canal may result in irritation of your spinal cord. Spinal cord narrowing causes symptoms of myelopathy.
• Narrowing of the neural foramen can impinge or irritate your spinal nerve roots. Neural foramen narrowing can cause radiculopathy (radiculopathy is often felt as pain and nerve symptoms that go down an arm or leg).

Exercise increases spinal flexibility, which helps reduces stiffness. It also strengthens your muscles, which can help protect the facet and other spinal joints. You should ask your healthcare provider for a complete treatment plan for your facet joint condition before starting an exercise regimen.

Whiplash and Facet Joint Pain

Facet pain after a car accident is not unusual. Chronic facet joint pain is a common symptom in people who had experienced whiplash. This type of facet joint pain may feel like muscle tenderness on either side of the center of the spine, where the facet joints are located.

If you’ve been involved in an auto accident or any other trauma where your spine was subject to whiplash, see your healthcare provider promptly. Getting an acute spine injury checked and treated early is absolutely key to avoiding serious spine damage or a chronic pain condition that may last years and have a negative effect on your quality of life.

Facet Injections

Injections can help in both the diagnosis and treatment of facet joint pain. Usually, an injection is considered only after you've tried four to six weeks of conservative treatment, with little or no success.

• A medial branch block is often regarded as the only definitive way to determine whether your spine pain is caused by damage to the facet joint. Your healthcare provider will inject a local anesthetic into the area. If that relieves your pain, you might be diagnosed with a facet joint problem. Medial branch blocks can provide some long and short-term relief. Still, the use of such injections tends to be limited to confirming that your pain indeed comes from the facet joints.
• A radiofrequency medial branch neurotomy (RF neurotomy) is often used for long-term pain relief. This type of injection heats the medial branch of the nerve that goes to the facet joint, deadening it. The idea is to block any pain signal coming from the facet joint, but clinical evidence that this actually works is limited.
  

A Word From Verywell

Back or neck pain can be caused by a combination of inflammation, degeneration, and muscle spasms—and it can affect multiple levels of the spine. Treatment usually involves several types of therapy, including medication and exercises. You'll first need to work with your doctor to identify the cause of your pain. Some of these diagnostic processes can involve a trial of treatments to see what works to relieve your pain.