Lower backŞişli, Istanbul
Lumbar facet joint syndrome treatment
The facet joints are small joints at the back of the vertebrae that guide movement. When overloaded they become irritated and produce pain, just like a knee or shoulder. Their hallmark is pain that increases with bending backward and eases on bending forward.
Also known as: Facet syndrome, facet arthropathy, zygapophyseal joint pain
What is it?
There are two facet joints at each vertebral level, and they determine how much the spine rotates and bends. With cartilage surfaces, a joint capsule and a rich nerve supply, they are joints in the full sense. Overloading, repeated strain or age-related wear can therefore turn them into a source of pain.
The most distinctive feature of facet pain is its sensitivity to position. Extending the spine brings the joint surfaces together and increases pressure; bending forward opens them and brings relief. Patients therefore struggle with prolonged standing but are comfortable working bent forward. Pain is usually felt in the back and buttock and does not travel below the knee.
Facet problems rarely occur in isolation; they usually accompany restricted movement in neighbouring regions. When the hip or thoracic spine does not move enough, the lumbar spine has to make up for it and the facet joints are overloaded. Treatment therefore addresses not only the painful segment but the neighbouring regions loading it.
Symptoms
- Low back pain that increases with bending backward and rotating the trunk
- Clear relief on bending forward and sitting
- Symptoms that worsen with prolonged standing
- Pain radiating into the buttock and back of the thigh, not below the knee
- Morning stiffness that eases with movement
- Point tenderness just to the side of the midline of the spine
- Difficulty straightening up when getting out of bed or after prolonged sitting
Causes and risk factors
- Repeated extension and rotation movements
- Increased load on the posterior joints as disc height decreases
- Restricted movement in the hip and thoracic spine
- Increased lordosis and anterior tilt of the pelvis
- Age-related wear of the joint cartilage
- A sudden unprepared twist or a fall
The assessment
The assessment uses loading tests combining extension with rotation to one side; facet-related pain increases clearly with that combination. Segment-by-segment manual examination narrows down which level is responsible.
Attention then turns to the source of the load: hip internal and external rotation range, thoracic rotation capacity and pelvic position are measured. Facet load will not fall permanently until restriction in those regions is addressed. The pattern of referral into the leg is questioned in detail to distinguish it from disc-related pain.
Course of treatment
Weeks 0–2
Unloading the joint
Positions that increase extension are temporarily limited. Manual therapy releases tension in the joint capsule and gently restores movement at the segment. Flexion-based positions that reduce pain are used in daily life.
Weeks 2–6
Freeing neighbouring regions
Hip and thoracic spine mobility are worked on. As these regions free up, the lumbar spine strains less to produce the same movement and the repeated load on the facet joints falls markedly.
Weeks 6–10
Establishing control
Trunk and hip strengthening make it possible to hold the spine in neutral throughout movement. Standing work, carrying and daily movements requiring rotation are retrained.
Maintenance
Preventing recurrence
Facet problems are prone to recurrence. A short daily routine that maintains hip mobility, together with a break pattern that interrupts long periods of standing, markedly reduces how often they return.
How long does it take?
Facet-related pain usually responds quickly; clear relief typically begins in the first two to three weeks and the programme runs 8–12 sessions. Where age-related joint wear is present, the goal is not complete resolution but reducing pain to a level that does not limit daily life and making flare-ups less frequent.
When to see a doctor
The findings below fall outside the scope of physiotherapy and require medical assessment.
- Pain and numbness travelling below the knee into the toes
- Progressive loss of strength in the leg
- Any change in bladder or bowel control
- Back pain accompanied by fever and night sweats
- Pain starting after a fall or impact and severely worsened by movement
Frequently asked questions
How is facet pain distinguished from a disc herniation?
The most practical distinction is its relationship to position. Facet pain increases with extension and eases with flexion; disc pain is usually the opposite and tends to radiate below the knee. Loading tests in the examination make the distinction clear.
Is an injection required?
In most cases no. It may be considered by a physician where physiotherapy delivered properly and for long enough has not helped, and pain completely prevents exercise. An injection reduces pain temporarily; lasting results still require exercise.
Why is it difficult to stand for long?
In standing the spine sits in slight extension and the facet surfaces come closer together. Pressure builds on the joint over time and pain begins. Shifting weight between feet or resting one foot on a step reduces that pressure.
Is this what is called arthritis of the spine?
When age-related wear develops in the facet joints it is reported as 'facet arthrosis' or 'degenerative change', and is commonly called arthritis. The finding is widespread and does not by itself mean the pain will be permanent.
Methods used
Related conditions
The content on this page is for information only and does not replace medical diagnosis or treatment. Always consult a healthcare professional about your symptoms.
Assessment appointment
No referral is required for assessment. Enquiries regarding Lumbar facet joint syndrome treatment may be submitted via WhatsApp; available dates and times will be provided in response.