Anatomy of the Lumbar Facet Joint
The spine is composed of 33 vertebrae, and the lumbar region houses the five largest vertebrae (L1-L5). Each vertebra forms a “tripod” structure: one large disc at the front and two facet joints at the back.
These facet joints allow the spine to flex, twist, and extend while also providing stability. The smooth, cartilage-covered surfaces of the joints are encased in fluid-filled capsules, reducing friction and ensuring smooth motion.
The nerves that supply the lower part of the body exit just above the facet joints, making them integral to both movement and sensory feedback. Due to their proximity with the joint, it also makes them susceptible to irritation if there is a problem with the facet joint.
Your spinal specialist will conduct a thorough assessment of your lumbar spine to identify the exact facet joint causing your pain. During a lumbar facet joint injection, a targeted dose of anti-inflammatory medication is delivered directly into the painful joint, aiming to reduce inflammation, relieve pain, and enhance mobility. This treatment can help you move more freely, sleep comfortably, and re-engage in exercise and rehabilitation; ensuring that your pain doesn’t just go away, but that you prevent any future flare-ups in the long term.
Functions of Lumbar Facet Joints
The lumbar facet joints serve several key functions:
When lumbar facet joints are compromised, people often experience limitations in daily activities due to the unique functions of these joints..
- Facilitate movement: Facet joints allow movements such as bending, twisting, and extending the spine. When these joints become inflamed or damaged, even simple tasks like tying shoes, reaching overhead, or turning to check blind spots while driving can become difficult and painful.
- Absorb stress: Facet joints absorb compressive and shearing forces as we move or stand. If the joints are compromised, this stress can’t be properly absorbed, leading to increased pressure on other structures. This can manifest as lower back pain during prolonged standing, walking, running, or when carrying heavy loads.
- Protection: Facet joints guide and restrict spinal motion to protect delicate structures like the vertebral discs, nerves, and spinal cord. When their protective function is impaired, people may experience instability in the lower back, making you more susceptible to back muscle strains or nerve impingement, resulting in symptoms like shooting pain, tingling, or weakness in the legs.
- Proprioception: Facet joints contribute to proprioception – our body’s sense of position and movement. When they aren’t functioning properly it can affect your balance and coordination, especially during movements that require spinal alignment, such as lifting weights, bending, or standing or walking on uneven ground.
In all these cases, damaged facet joints affect not just movement but the ability to perform everyday tasks comfortably, making effective treatment like spinal injections and Physiotherapy essential for improving quality of life.
Causes of Lumbar Facet Joint Pain
Lumbar facet joint pain can result from injury or degeneration (wear and tear). Injuries might make the joint too stiff or excessively mobile, while wear and tear over time can affect the cartilage, leading to inflammation and irritation.
Degenerative Disc Disease is a common cause of secondary facet joint pain. As the lumbar discs degenerate and lose height, the space between vertebrae narrows, putting increased pressure on the facet joints. This eventually leads to osteoarthritis, where the joint surfaces wear down, resulting in pain and stiffness.
Risk Factors for Lumbar Facet Joint Pain
Several factors can increase the likelihood of developing facet joint pain:
- Age: Degenerative facet joint pain is more common in individuals over 40, while injuries are more frequent in those under 40.
- Obesity: Extra weight adds stress to the lumbar joints.
- Sports: High-impact or rotational sports like football, basketball, or tennis can stress the joints.
- Manual Jobs: Jobs involving heavy lifting or repetitive movements can lead to joint strain.
- Spinal deformities: Poor posture or abnormal spine alignment can overload the joints.
Symptoms of Lumbar Facet Joint Pain
Lumbar facet joint pain typically presents as intermittent, localised lower back pain that may worsen over time if left untreated. The pain often radiates to the buttocks or upper thigh but rarely travels below the knee. Symptoms are usually one-sided, though bilateral pain can occur if both joints are affected.
Common signs of lumbar facet joint pain include:
- Dull ache in the lower back.
- Sharp pain radiating to the buttocks or thigh.
- Muscle weakness in the affected leg.
- Pain during twisting or bending backward.
- Stiffness, especially in the morning or after inactivity.
- Crepitus, or a grinding sensation in the joints.
It’s important to seek professional diagnosis to ensure that facet joint pain isn’t mistaken for other spinal issues like spondylolisthesis.
Diagnosing Lumbar Facet Joint Syndrome
Facet joint pain is best diagnosed by a spinal specialist – Physio or Sports Doctor, who will assess your symptoms and conduct a hands-on physical examination of your spine. Your physiotherapist or sports physician will assess:
- Range of movement of the spine.
- Muscle strength of your core muscles and lower leg muscles.
- Sensory and motor function.
- Spinal posture and stability.
In some cases, imaging studies such as X-rays, Ultrasound, CT scans, or MRIs may be necessary to confirm the diagnosis or rule out other conditions.
Please note that if you are having a spinal injection, then you will need to have an up to date MRI scan that has been done within the last 6 months. We can help arrange these for you if they are required.
Treating Lumbar Facet Joint Pain
The initial treatment for lumbar facet joint pain is typically conservative, focusing on physiotherapy and pain management.
Physiotherapy
A tailored physiotherapy plan is essential to address the underlying issues of facet joint pain. Treatment may include:
- Soft Tissue Therapy: Massage to reduce muscle tension and spasms.
- Joint Mobilisations: Manual therapy to address joint stiffness.
- Stretching Exercises: Targeted movements to increase joint range of motion.
- Strengthening Exercises: Programs designed to improve core and back stability.
- Posture Correction: Ergonomic assessments and adjustments to avoid further strain.
At Complete Physio we have an incredibly experienced team of expert spinal physiotherapists who bring a wealth of skills and expertise.
Each team member is highly trained in assessing complex spinal issues, specialising in advanced diagnostic methods to precisely identify the source of pain or dysfunction and using evidence-based treatment strategies—such as manual therapy, tailored exercise programs, and patient education—they provide personalised, effective care aimed at achieving long-term management and recovery.
Medication
Your healthcare provider may recommend pain relievers, anti-inflammatory drugs, or muscle relaxants to alleviate discomfort. Please make sure you get advice from a GP or Healthcare professional before taking any medication.
Acupuncture and Dry Needling
These therapies can be effective in reducing pain and muscle tension, promoting circulation, and facilitating healing.
Lumbar Facet Joint Injections
If your pain and symptoms are not settling with conservative treatment alone, and you are suffering with severe night pain or long standing pain that is affecting your work and mental health, then it might be that you would benefit from having an ultrasound guided spinal injection.
Facet joint injections are a minimally invasive option for patients who do not respond to conservative treatments. These injections combine a local anaesthetic and corticosteroid, which are delivered directly into the joint using ultrasound guidance. The steroid reduces inflammation, while the anaesthetic blocks pain signals, offering relief that can last from weeks to months. It might be that you need to have injections at one of multiple levels, depending on the number of joints affected.
If there are a multiple structures that are causing your symptoms; ie facet joints plus nerve root irritation (Sciatica) Please ADD LINK TO THIS CONDITIONS PAGE then it might be necessary to administer an injection that specifically targets the nerve root.
At Complete Injections, we have a Specialised Ultrasound Guided Spinal Injections Service in London, led by Dr. Matteo Bernardotto, a Consultant in Musculoskeletal, Sport and Exercise Medicine at University College London Hospitals (ULCH).
He is highly skilled in administering ultrasound guided spinal injections, ensuring precise and effective pain relief.
Importance of Rehabilitation After Injections
While Facet joint injections often provide immediate, short term pain relief they are not be used as a ‘quick fix’. They should always be used as an adjunct alongside a physio guided rehabilitation program.
Once your pain subsides, it’s important to work with your physiotherapist to restore function and prevent recurrence. They will guide you through an individualisation exercise programme to improve posture, strength, and mobility, which are essential for your long-term recovery.
Surgery for Lumbar Facet Joint Pain
Surgery is rarely necessary for facet joint pain, but in cases where conservative treatments and injections have failed, a spinal fusion may be considered. This option is usually reserved for patients with significant nerve root compression, instability, or severe joint degeneration. If surgery is required, our team will coordinate your care with top spinal surgeons, ensuring a smooth and streamlined recovery.
Book a Consultation
If you are experiencing low back pain that you suspect might be lumbar facet joint pain, and want to explore treatment options, including injections or physiotherapy, don’t hesitate to contact Complete Injections.
Call us at 020 7482 3875 or email info@completeinjections.co.uk to book an appointment and start your journey to pain relief and a renewed quality of life.
