What Is Facet Joint Syndrome? Does It Cause Morning Back Pain?
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Facet Joint Pain Overview
Facet joints are paired vertebral joints found on the spine. They also have another name, the “zygapophyseal joints,” but that’s a mouthful, so most people just call them the facet joints. There is one facet joint on each side of the spine at the cervical, thoracic, and lumbar level.
Facet joints are like other joints in the body with joint cartilage and a lubricating joint fluid called synovial fluid produced by a joint lining called the synovium. This is identical to other joints like the knees and hips. Facet joints, along with spinal disks, help to provide support and mobility during movement at each vertebral level. In simple mechanical terms, facet joints are like hinges that allow the spine to bend, flex, and extend while restricting excessive movement (hyperextension). By connecting adjacent vertebrae, facet joints help to support load distribution during weight bearing activities.
Facet joint syndrome, also known as facet syndrome or facet joint arthropathy, occurs when the facet joints become the source of back or neck pain. Chronic low back pain is often associated with facet joint syndrome and is usually described as an ache or stiffness. Facet joint pain is often accompanied by spine muscle tenderness that may intensify when light pressure is applied to the skin over the irritated facet. Symptoms can come and go, can be minimal at times, but can flare with moderate to severe activity.
Table of Contents
Symptoms
Diagnosing
Treatments
Patients Ask:
What Causes Facet Joint Syndrome?
Texas Back Institute Responds: As with other joints in the body, osteoarthritis and wear and tear are the most common causes of Facet Joint Syndrome. As we age, it’s common for the cartilage in various joints to break down, be damaged, or get thinner. When this happens in the spine, it’s called Facet Joint Syndrome.
Other Causes of Spinal Joint Pain, Including Facet Joint Osteoarthritis
There are many conditions that cause spinal joint pain. Other conditions such as rheumatoid arthritis, ankylosing spondylosis, trauma or whiplash, and stresses related to degenerative disk disease, scoliosis, or prior back surgery can also contribute to spinal joint pain. Inflammation and pain in the facet joints are most common in older populations as a degenerative process, but can also occur in younger people, particularly if there’s a history of prior spine trauma including fracture and whiplash.
Facet arthritis, bone spurs, and thickened ligaments contribute to facet joint syndrome. In more advanced cases of facet arthritis, bone spurs can form and /or joints enlarge and pinch spinal nerves or the spinal cord. Radicular pain or spinal stenosis symptoms – including Myelopathy (an injury to the spinal cord) can occur if the joints in the neck or thoracic area enlarge enough to compress the spinal cord itself.
Others include:
- Sciatica: When spinal nerve roots are irritated or compressed at the facet joint, it can lead to radicular pain (pain that radiates along the path of a nerve root) to the buttock, thigh, leg, and/or foot. Muscle weakness and fatigue may also occur in the affected leg. This is commonly known as sciatica.
- Pinched Nerve: This occurs when surrounding tissues (bones, muscles, or tendons) compress a nerve, resulting in pain, tingling, numbness, or weakness.
- Spinal Stenosis: This is a condition caused by the narrowing of the spinal canal, which leads to pressure on the spinal cord or nerve roots.
What are the Symptoms of Facet Joint Syndrome?
Spine specialists like those at Texas Back Institute are well-trained in the detection of the symptoms of facet joint syndrome. They will assess your symptoms, perform a physical exam, and check for tenderness over the affected facet joints. These include:
- Cervical Facet Joint Pain: This can result in neck pain that radiates into the shoulder or shoulder blade area, and/or headache. Stiffness in the neck and muscle tenderness are also common. It’s also common to experience sensations or sounds described as “grinding, popping, cracking, gravel, or sandpaper” in the neck or back. Cervical facet pain can cause pain and discomfort when turning the head while driving or difficulty relaxing the neck at night when lying down. Cervical facet joint pain may cause headaches that can range from mild to severe, usually felt in the forehead, temples, or back of the head. These headaches are typically caused by the upper three joints on either side of the spine (C0-C1, C1-C2, or C2-C3). Another cause can be muscle spasms irritating the suboccipital nerves and leading to headaches.
- Thoracic Facet Joint Pain: Pain is experienced in the middle back, ranging from mild to severe, usually at the level of the shoulder blades or below. This can result in a restricted range of motion, swelling and tenderness, and muscle spasm. Severe irritation of the nerve roots may cause pain around the chest, abdomen, or extremities.
- Lumbar Facet Joint Pain: This pain typically presents as low back pain with radiation into the buttock, hip, or thigh. Symptoms of facet joint pain in the back and neck are often worse in the morning and improve after walking around and limbering up. Symptoms worsen due to prolonged sitting or standing – which can make standing upright out of a chair difficult – and typically improve when movement is resumed. Lumbar facet pain can cause difficulty lying flat on one’s back. If the arthritis is causing a pinched nerve or spinal stenosis symptoms, it can include arm or leg pain, numbness, tingling, or muscle weakness.
Most patients will have spinal tenderness overlying the affected area. Pain is often aggravated by leaning back (extension) and/or twisting (rotation) of the neck or back and can be relieved by bending forward (flexion).
Patients Ask:
Why is my neck and/or back pain worse in the morning when I wake up?
Texas Back Institute Responds: Facet joint pain tends to be worse in the morning. During sleep, you don’t move as much. When you’re relatively inactive, it can aggravate the facet joints and lead to stiffness and reduced joint mobility. Movement is what helps keep the joints lubricated and functioning smoothly. As a result, when you wake up, you may experience increased pain and discomfort in the facet joints.
Patients Ask:
Does Facet Joint Syndrome go away?
Texas Back Institute Responds: Facet joint syndrome itself cannot be cured, but the pain associated with this condition can be controlled.
How is Facet Joint Syndrome Diagnosed?
Diagnosis of this condition is initially based upon clinical and physical evaluation. To diagnose facet joint pain, a thorough physical examination is essential, often supplemented by medical imaging and diagnostic injection tests. A spine specialist will assess medical history and symptoms, looking for signs such as localized pain, referred pain to other areas, radiating pain, tenderness upon palpation, and if the pain is worsened by different postures and certain activities.
Diagnostic imaging (X-ray, CT, and MRI) of the facets is often non-specific since visual evidence of joint arthritis (facet hypertrophy) on diagnostic imaging is not always a correlating indicator of facet joint pain. Imaging can be utilized to evaluate spinal disorders which may create similar symptoms or identify a pinched nerve or spinal stenosis. After an appropriate period of conservative care with medication, physical therapy, and/or chiropractic treatment, diagnostic facet block injections can be utilized to confirm suspected joint pain. Facet joint interventions, including procedures and techniques such as fluoroscopy-guided injections with anesthetics, are used to accurately diagnose pain associated with facet joint disorders.
What is the Best Treatment for Facet Joint Syndrome?
The initial step for treatment of Facet Joint Syndrome is conservative care consisting of activity modification, stretching, physical therapy, chiropractic manipulation, and/or medications. Facet joint injection can also be used as a diagnostic and therapeutic tool, where a local anesthetic and corticosteroid are injected into the facet joint to evaluate pain relief and confirm if the facet joint is the pain source.
- Activity Modification: It is necessary to maintain good posture. Using correct sitting, standing, and lying down posture reduces stress on the facet joints. Patients should avoid spinal twisting, repeated bending, and prolonged sitting. Bending the spine backwards should be minimized.
- Stretching: A stretching routine can help to alleviate discomfort. Stretches like knee-to-chest, pelvic tilt, and child’s pose gently stretch the back and hips. Physical therapists recommend active treatments that include stretches and strengthening exercise. Other stretches include neck stretches, lumbar spine stretches, and hip flexor stretches.
- Physical Therapy: Stretching and strengthening exercises are recommended to improve the strength of the supporting spinal muscles and restore normal spinal posture and range of motion. Physical therapists could recommend strengthening exercises and low-impact aerobics activities like walking or swimming, core training to strengthen abdominal muscles, and balance training with support. A spine specialist or a physical therapist can customize an exercise plan that meets specific needs.
- Chiropractic Manipulation: Chiropractic adjustments aim to reduce pressure and enhance mobility by alleviating strain on the facet joints, leading to less neck and/or back discomfort. Additionally, chiropractic manipulation can improve overall joint health by increasing blood flow and reducing inflammation. Other passive treatments include such things as hot and cold therapy, anti-inflammatory medication, muscle rubs, electrical stimulation, ultrasound, traction, and massage which are used to relieve muscle tension and pain caused by underlying joint pain. These treatments provide pain relief for patients suffering from facet joint disorders.
Patients Ask:
What aggravates facet joint pain?
Texas Back Institute Responds: There are several factors that can contribute to facet joint pain. For example, age is a factor. Facet joint syndrome is more common in older people due to “wear and tear” on the facet joints. Gender plays a role. Facet joint pain is more common in women. Body weight is a factor. People with a BMI (body mass index) over 30 are at higher risk. Poor posture can contribute to facet joint pain by altering the alignment and movement of facet joints. Prior damage to vertebral disks can lead to arthritis in the facet joints, as can a family history of degenerative arthritis.
In addition, people with this condition need to be careful when exercising to prevent aggravating the facet joints. Some exercises to avoid include sit-ups and crunches, leg-lifts, running or jogging, torso twists, and straight-legged deadlifts. All these exercises can strain the spine, potentially worsening symptoms.
What are Facet Joint Injections?
If symptoms persist, diagnostic facet injections, also known as a facet block, can be performed to block pain in the joint area. A facet joint injection targets the synovial membrane tissue of the joint capsule to reduce inflammation in the facet joints while medial branch blocks target the medial branch nerve fibers by disrupting the nerve signal to the brain.
If the procedure is successful in producing temporary pain relief, the facet joint is confirmed as a cause of back pain. The steroid typically becomes effective in 48-72 hours after the procedure and will last in the body for up to one week. However, the therapeutic effect of the medication can persist much longer in many patients. Normal physical activity, such as walking, work, and basic household chores can resume the day after the procedure with a gradual increase in more intense physical activity in the week following the procedure, as tolerated.
Next Steps in Treatment
Finally, a rhizotomy (also called radiofrequency ablation or radiofrequency neurotomy) can be performed. RFA uses radio waves to create a current that heats a small area of nerve tissue. The heat destroys that area of the nerve, stopping it from sending pain signals to the brain and is successful in reducing chronic pain with conditions like spinal arthritis and sacroiliac joint pain. Rhizotomy can provide longer lasting pain relief, ranging from months to years – typically 6-18 months.
Patients Ask:
What Kind of Doctor Treats Facet Joint Syndrome?
Texas Back Institute Responds: A comprehensive team approach is key to diagnosing and treating Facet Joint Syndrome and includes several types of specialists.
- Orthopedic Surgeon: The spine specialists at TBI specialize in diagnosing and treating musculoskeletal conditions. They can perform surgical interventions, if necessary.
- Physiatrists (Physical and Rehabilitation Specialists): These specialists focus on non-surgical treatments, including physical therapy, medications, and injections for pain management.
- Pain Management Specialists: These specialists offer a comprehensive approach to pain relief that could include medications, facet joint injections, and minimally invasive procedures like RFA.
Living with Facet Joint Syndrome
Although Facet Joint Syndrome can’t be cured, this condition can be managed effectively. The awareness of activities that take the weight off the facet joint, such as periodically leaning forward while sitting or changing position frequently may help ease the pain.
Patients may be advised to adjust their sleep positions to take the pressure off facet joints. It’s common for people with Facet Joint Syndrome to have difficulty getting out of bed in the morning. Many people with this condition report that the pain and stiffness are worse upon waking, due to inactivity while sleeping.
To minimize discomfort and to safely get out of bed, follow these tips:
- Roll to the Side – Lying on your back, you bend your knees slightly and roll to your side. Use your arms to push up into a seated position.
- Avoid Twisting – As you sit up, try to avoid twisting your spine. Try to keep your knees and hips in alignment.
- Slide the Legs Off – Slowly slide your legs off the bed. Try to keep your knees and hips aligned and use your arms to support your upper body.
- Push Up with the Arms – Placing the hands on the bed next to the hips, begin to push up with the arms to stand up.
Making Lifestyle Changes
Cooperation with a treatment plan plays a central role in managing facet joint pain. Patients can minimize painful flare ups by regular stretching and the application of hot and cold therapy. They can implement an exercise routine that lasts at least 20 minutes daily and plan to modify activities based on how they’re feeling. Consistency is the key to increasing mobility. Techniques to improve posture can have a significant impact on back pain. Imagine a straight line from the ceiling to the floor and align ears, shoulders, hips, knees, and ankles vertically. Stretches to improve posture include a shoulder blade squeeze, upper body stretch, and arms across the chest.
Every person is a unique individual. Lifestyle changes like maintaining a healthy weight and posture awareness are within a patient’s control. For optimal outcomes, follow medical advice and adapt to lifestyle changes that are based on symptoms and comfort level.
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Frequently Asked Questions
As with other joints in the body, osteoarthritis and wear and tear are the most common causes of Facet Joint Syndrome. As we age, it’s common for the cartilage in various joints to break down, be damaged, or get thinner. When this happens in the spine, it’s called Facet Joint Syndrome.
Facet joint pain tends to be worse in the morning. During sleep, you don’t move as much. When you’re relatively inactive, it can aggravate the facet joints and lead to stiffness and reduced joint mobility. Movement is what helps keep the joints lubricated and functioning smoothly. As a result, when you wake up, you may experience increased pain and discomfort in the facet joints.
Facet joint syndrome itself cannot be cured, but the pain associated with this condition can be controlled.
There are several factors that can contribute to facet joint pain. For example, age is a factor. Facet joint syndrome is more common in older people due to “wear and tear” on the facet joints. Gender plays a role. Facet joint pain is more common in women. Body weight is a factor. People with a BMI (body mass index) over 30 are at higher risk. Poor posture can contribute to facet joint pain by altering the alignment and movement of facet joints. Prior damage to vertebral disks can lead to arthritis in the facet joints, as can a family history of degenerative arthritis.
In addition, people with this condition need to be careful when exercising to prevent aggravating the facet joints. Some exercises to avoid include sit-ups and crunches, leg-lifts, running or jogging, torso twists, and straight-legged deadlifts. All these exercises can strain the spine, potentially worsening symptoms.
A comprehensive team approach is key to diagnosing and treating Facet Joint Syndrome and includes several types of specialists.
- Orthopedic Surgeon: The spine specialists at TBI specialize in diagnosing and treating musculoskeletal conditions. They can perform surgical interventions, if necessary.
- Physiatrists (Physical and Rehabilitation Specialists): These specialists focus on non-surgical treatments, including physical therapy, medications, and injections for pain management.
- Pain Management Specialists: These specialists offer a comprehensive approach to pain relief that could include medications, facet joint injections, and minimally invasive procedures like RFA.
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