Lumbar Facet Joint Pain

Lumbar facet joint pain, also known as facet joint syndrome, is a condition impacting the joints positioned on either section of the lumbar vertebrae. These joints can be excessively strained due to sudden trauma or become inflamed from wear and tear or repetitive use. As a result, it can lead to severe pain, restricted movement and reduced function.

This type of pain is a leading cause of both lower back and neck discomfort. While it can occur anyplace along the spine, it most frequently affects the lumbar region. This area normally endures substantial weight and pressure, making it prone to injury and deterioration. In the lower back, the L4-L5 level is the common spot of facet joint pain that L5-S1 follows.

Symptoms of Lumbar Facet Joint Pain

Lumbar facet joint pain typically presents as sporadic occurrences of localised lower back discomfort. It occurs intermittently a few times per year. If not treated, these episodes may increase in severity and frequency. Sometimes, pain may extend into the buttocks or the back of the thigh; but rarely radiates beyond the knee.

Symptoms usually affect one side of the lower back, buttock, or thigh. However, bilateral pain can occur if both facet joints at the same spinal level are involved—though this is less frequent.

According to the number of affected joints, the severity of the condition, and whether an adjacent nerve root is involved, one or more of these symptoms may appear:

Dull, localised lower back pain
Pain radiating into the buttock or thigh’s back – if a spinal nerve is inflamed, sharp, shooting discomfort (sciatica) may extend down the leg.
Muscle weakness sensation in the affected leg
Tenderness upon touch – pain may worsen when the lower back is pressed gently.
Increased discomfort with rotation, twisting, or backward bending
Pain that worsens with heavy activity or workout
Pain relief when bending forward
Lower back stiffness – often more noticeable in the morning or following inactivity but improves upon recommencing normal activity.
Crepitus – a sense of grinding or grating in the back joints with motion

If pain extends into the lower leg, particularly with numbness or tingling, degenerative disc disease may be the underlying cause. However, both conditions can coexist because of their close anatomical relationship.

Facet joint pain can resemble other spinal disorders like spondylolisthesis. Hence, seeking a precise diagnosis from a qualified healthcare professional is crucial.

Causes

Lumbar facet joint pain primarily results from facet joint injuries, which can either make the affected segment overly stiff or excessively mobile. Also, it could stem from prolonged wear and tear or a combination of both.

Often, the discomfort originates from the nearby tissues rather than the joint itself. The spine is a highly complicated structure consisting of 33 vertebrae—five of which form the lumbar region (L1-L5)—as well as intervertebral discs, muscles, ligaments, nerves, and tendons. Damage or degeneration of a facet joint can trigger muscle spasms, inflammation, or heightened nerve sensitivity. All these can be managed with conservative treatments and physiotherapy.

Another potential cause is degenerative disc disease, which can lead to secondary facet joint syndrome. As lumbar discs deteriorate, the gap between vertebrae decreases, placing additional strain on the facet joints. Over time, this pressure accelerates joint wear, leading to irritation, pain, and, ultimately, osteoarthritis of the lumbar spine.

Risk Factors

Several factors can increase the likelihood of developing facet joint pain, including:

Obesity – Excess body weight increases stress on the lumbar joints.
Contact sports – Activities like football or rugby.
High-impact sports – Basketball, gymnastics, netball, and dance.
Rotational sports – Golf, tennis and hockey.
Occupations involving heavy lifting or frequent bending.
Injuries to the lumbar spine.
Age – Those above 40 years are more likely to develop pain from degeneration. Likewise, younger individuals often experience pain due to trauma, overuse, or joint overstretching.
Degenerative disc disease – This condition increases the risk of facet joint pain.
Poor spinal posture or deformities.

Diagnosis

A specialist physiotherapist, through a detailed hands-on assessment, can precisely diagnose lumbar facet joint pain. With their expertise, they will evaluate each spinal level to identify the particular facet joint causing discomfort and determine whether it is stiff, locked, or unstable.

During your physical examination, the physiotherapist will assess:

Range of movement
Sensory function
Muscle strength
Reflex responses
Pelvic and core stability
Spinal posture

Imaging tests like CT scans, X-rays, or MRIs may be recommended to confirm the diagnosis and rule out other spinal conditions. If a scan is necessary, your physiotherapist can refer you to an expert consultant for further evaluation.

Treatment for Lumbar Facet Joint Pain

Facet joint-related mechanical lower back pain is usually managed with conservative treatments as the first course of action.

Physiotherapy:

Your physiotherapist will develop a personalised treatment plan based on your symptoms and recovery goals. This plan may include:

Medication – Pain relievers, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants may help manage symptoms. Always consult a healthcare professional before taking medication.
Soft tissue therapy – Massage can reduce tension, relieve muscle spasms, and promote relaxation.
Acupuncture or dry needling – Having been used for centuries, acupuncture helps alleviate pain and muscle tightness.
Back stretches – Specific stretching exercises improve joint mobility and muscle flexibility.
Joint mobilisation & manipulation – Hands-on techniques may be used to address facet joint stiffness or restrictions.
Posture re-education – Physiotherapists assess movement patterns and posture. This helps provide corrections and ergonomic adjustments for workplace-related discomfort.
Strength & endurance training – Strengthening exercises focus on spinal stability and deep postural muscles stabilising and controlling the pelvis and lower back. Pilates is often recommended to effectively improve mechanical low back pain.
Functional Rehabilitation – This treatment is tailored to restore movement and function for work, sports, or daily activities. This enables you to safely resume your normal activities.

Lumbar facet joint injections:

If pain persists, a facet joint injection may be considered. This minimally invasive technique involves an injection of a mixture of local anaesthetic and corticosteroids into the joint under X-ray (fluoroscopy) guidance. The injection reduces inflammation and blocks pain signals to the brain, offering relief that can last for weeks to years. If necessary, the procedure might have to be repeated.

Lumbar facet joint injections should not be the sole treatment but should complement physiotherapy. Rehabilitation should resume about a week after the injection.

Surgical intervention:

Surgery is not often needed but may be considered when conservative treatments fail. This is especially the case if facet joint enlargement, spinal instability or degenerative disc disease is causing nerve compression. In such cases, spinal fusion surgery may be recommended.

If surgery is required, a referral will be made to a spinal specialist. Post-operative rehabilitation will follow to support full recovery and a return to activity.

Conclusion

Lumbar facet joint pain can significantly impact daily life. But relief is possible with the right treatment approach—including physiotherapy, targeted exercises, and, if necessary, injections or surgical intervention. Addressing symptoms early and following a structured rehabilitation plan can help restore mobility, reduce discomfort, and prevent future flare-ups.

If you’re experiencing persistent lower back pain, don’t wait for it to worsen. Book an appointment with our specialist physiotherapist today for a personalised assessment and start your journey toward pain relief and recovery.