Not quite as common as disc injuries but facet joint dysfunction can be just as painful. Research indicates that 10-40% of back pain is primarily caused by the facet joint. Facet joint pain presents in 2 distinct ways. Firstly, it can be a localised “here is my pain” sharp sensation that seems to be contained off to one side of the lower back. Or secondly it can present itself as a diffuse lower back ache that can spread to the buttocks and, in some cases, also into your thigh. Generally, movements like bending backwards or leaning towards the painful side will worsen the symptoms. Standing or walking for long periods may also worsen facet joint lower back pain.

What is a facet joint?

The facet joint is where each vertebra joins to the vertebra above and below. There is a facet joint on the left and facet joint on the right. It forms a three-pronged joint structure along with the disc as well. See the following picture.

posterior spinal segment

How did I cause this problem?

Back pain arising from the facet joints can have many contributing factors and overlapping causes. However, some of the main causes of facet joint pain are:

  • Repetitive activities that involve a lot of bending, twisting and rotation of the lower back as well as positions that place your back in extension such as bowling in cricket or paddling whilst surfing
  • Poor posture and control; your lumbar spine biomechanics shifts more tension onto any of the facet joints in your lower back.
  • Age related changes in the spine. As we get older or cartilage and joints begin to slowly wear down. This is particularly the case if you also have lumbar spine arthritis.


How can Physiotherapy Help?

For Facet joint dysfunction we focus on two key aspects of treatment: mobilising the facet joint that’s causing you pain and then strengthening your lower back. We will also look at any contributing factors in your activities as to why there was more strain on your facet joint so the pain doesn’t recur.

The first aspect is to help settle your pain and discomfort whilst regaining your range of movement. We can unload the facet joint by utilising manual therapies such as massage, dry needling, taping, heat or ice. Here at Fixio our physiotherapists are experts at manually targeting the stiff facet joint to help unlock movement and reduce your pain.  We may also start you on simple exercises to maintain your range of motion in your back. We’ll also talk about how you can do what you need to do in work and life without putting extra pressure on your facet joint. For example, if you walk long distances and this tends to flare up your pain, we can look at targeted specific exercises to intersperse in between your walking to take the pressure off the facet joint helping to avoid flare ups.

After the pain is beginning to settle, we will look at progressing your exercise program, because strengthening is what prevents recurrence. We’ll focus on exercises tailored to your individual goals. For instance, if you want to return to playing netball or football, our exercises may focus around a return to run program, lateral movement, jumping and landing whilst maintaining correct muscle activation and pelvic and lumbar spine control to offload the pressure on the problem facet joint area.

From easing your pain to getting you back onto your feet and doing the things you love best, we’ve got your back (literally).


By Damien Glover