There are 24 vertebrae that stack on top of each other to form your spinal column. At the back of each vertebrae is a facet joint that connects one vertebrae to its neighbour.

Your facet joints give your spine stability, particularly if the discs between your vertebrae have degenerated.

The two lowest facet joints in your lower back are the most common source of facet joint pain. When a facet joint is damaged or inflamed, the nerve associated with it can produce pain.

You might experience that as back, buttock or leg pain – which could travel all the way down to your foot.

Symptoms such as pain when sitting or getting up can be due to other causes, such as the disc, and don’t necessarily denote facet joint issues.

Facet joint injuries most commonly occur in association with trauma, particularly falls and car accidents.

Your facet joint may also become painful if it:

• Is taking more of the body’s load, for example if you’re overweight or if you have age-related disc degeneration.

• Has experienced repetitive microtrauma, for example a truck driver who always hops out of the cab onto the same leg.

Symptoms such as pain when sitting or getting up can be due to other causes, such as the disc, and don’t necessarily denote facet joint issues.

Diagnosing facet joint pain is complicated because X-rays, CT scans, bone scans and MRIs cannot establish whether or not a facet joint is the source of pain.

The most reliable way to diagnose facet joint pain involves using an X-ray controlled anaesthetic injection into either the joint or its nerve supply. If the injection temporarily makes the pain go away, it’s a good indication that the problem is in your facet joint.

However, this result can only be trusted if your pain is consistent. If it tends to come and go by itself, then it’s hard to know whether the injection made the pain go away or whether it subsided by itself.

The pain sometimes goes down my leg – how does that come from the back?

Referred pain is caused by one part of your body but felt in another.

Referred facet joint pain can be sharp and severe at times in the back, where it is felt most strongly. It tends to be duller in the leg.Nerve pain tends to concentrate more in the leg and has a thinner, shooting quality.

Treatment

Facet joint pain can present as an acute attack, which eases quickly, or can build up over time and last longer.

It’s not always possible for your doctor to confidently predict what will happen in the long term. However, in our experience, many patients recover well.

What should I be doing with my facet joint injury?

Facet joint injuries are notoriously difficult to prevent.

However, evidence and common sense suggest the following to be good practice:

• During an acute attack, start stretching as soon as possible – resting during the attack may only prolong it

• Assess and change your ergonomics both at work and at home

• Keep active – find activities that do not exacerbate your pain following exercise

• Pool exercise can be beneficial if the pain is severe.

Once I have had a facet joint injury will it always be a problem?

Not necessarily. Facet joint pain can resolve and heal.

However, once you have had a first attack of low back pain, your body changes the way it supports the spine. You may then be more susceptible to other types of low back pain. This is because your body has lost its protective mechanisms for the spine.

Physiotherapists can train you to rehabilitate your muscular system to protect your spine.

Do I need to get a scan to show my facet joint injury?

X-rays and CT scans may be useful for facet joint injuries.

However, the majority of facet joint injuries resolve quickly without the need for scans. In an acute situation, a diagnosis is made purely on clinical presentation. For chronic pain, more involved tests are required to make the diagnosis.

Your doctor(s) will decide whether you need scans based on the unique features of your case.

We urge caution with SPECT nuclear medicine scans and MRI for facet joint pain because of the high false-positive rates. These scans may detect an abnormality (most of us have a few oddities) but that doesn’t mean it’s facet joint pain

Should I use medication?

If you present with acute (sudden onset) pain, then your doctor may prescribe medication to ease the pain, inflammation and/or muscle spasm. You may need this relief for a week or so.

If pain persists past that, see your doctor again to review your diagnosis and medication. Don’t adjust your medicine by yourself as the right treatment varies depending upon individual circumstances.

Is there any proven treatment?

The only treatment proven to work for facet joint pain is radiofrequency neurotomy that targets the nerve supply to the joint.

Unlike the hip, knee and shoulder joints, there is so far no joint replacement available. Regenerative therapies may play a role, but these have yet to be tested