As a chiropractor, I evaluate patients with spinal pain every day. One of the most common patterns I see is irritation of the facet joints of the spine, often referred to as facet syndrome .
Many patients are told by their PCPs or Orthopedists that have “functional” or “non- specific” back pain, meaning no clear cause is seen on imaging such as X rays or MRI. However, this does not mean there is not a source of pain.
Research shows that approximately 70-80% of back pain is classified as functional or non- specific. Within that group, studies suggest that facet joints may account for 30-40% of cases.
It is remarkable that such small structures, about the size of your fingernail, can be responsible for significant neck and low back pain.
What Are Facet Joints
A simple way to understand facet joints is to think of the spine as a stack of building blocks.
Between each block sits a disc that acts like a cushion. At the back of the spine are the facet joints, which act like hinges, guiding movement and providing stability.
Each vertebra has two facet joints on the right and two on the left, connecting it to the vertebra above and below. These joints are lined with cartilage and surrounded by a small capsule filled with fluid, similar to joints in the knee or shoulder.
Although each facet joint is only about the size of your fingernail, it plays a critical role in every movement of the spine.
What Is Facet Syndrome and How Does It Occur
Facet syndrome occurs when these facet joints become irritated, inflamed, or restricted in their movement.
This typically develops over time rather than from a single event and may be caused by:
Repetitive motion or overuse
Poor posture
Degenerative changes (or wear and tear)
Previous injuries
Reduced spinal mobility
Improper lifting mechanics
When facet joints become irritated, they can produce localized pain and stiffness in the neck, mid back, or low back depending on the level involved.
Many patients notice that pain increases when bending backward or rotating, and often improves when leaning forward or changing positions.
How Is Facet Syndrome Diagnosed
Diagnosis begins with a thorough history and physical examination.
During the evaluation at Performance Health Center we assess:
Spinal movement
Areas of tenderness along the spine
Pain patterns with extension and rotation
Joint motion and muscle tension
Patients with facet irritation often report pain when bending backward or rotating. Motion usually relieves pain, where being sedentary, or sitting usually provokes facet joint pain.
Imaging such as X rays or MRI may show degenerative changes, but facet syndrome is most often identified through clinical examination and movement testing rather than imaging alone.
How Chiropractic and Soft Tissue Therapy Help
Chiropractic care focuses on restoring normal joint motion, reducing irritation, and improving overall spinal function.
Gentle chiropractic adjustments help restore movement in restricted facet joints and reduce mechanical stress on the spine.
Because irritated joints often cause surrounding muscles to tighten, addressing soft tissue is equally important. Techniques such as Active Release Techniques® can reduce muscle tension and decrease stress on the affected joints.
Self Care to Help Reduce Irritation
Ice therapy can be especially helpful during flare ups.
Apply an ice pack to the painful area for about twenty minutes, then remove it for at least one hour before repeating. This can help reduce inflammation and calm irritated tissues.
Ice is especially helpful:
After physical activity
When the area feels sore or inflamed
During acute pain episodes
Exercises for Facet Syndrome
Exercise plays an important role in long term recovery. The goal is to improve spinal stability, restore mobility, and reduce stress on the facet joints.
Common exercises include:
Pelvic tilts to activate the core and reduce stress on the lower back
Cat cow movements to promote gentle spinal mobility
Bird dog exercise to strengthen stabilizing muscles of the spine
These exercises help the spine move more efficiently and prevent overload of the facet joints during daily activities.
Final Thoughts
Facet joints may be small, but they can have a significant impact on your comfort and function.
They are a common and often overlooked source of functional back pain. The good news is that with proper diagnosis, targeted care, and consistent self care, most patients experience meaningful improvement.
Understanding the role of these small joints provides a clear explanation for pain that is often labeled as non specific.
For more information contact me at DrJayAtwi@performancehealthcenter.com
Dr. Jay Atwi
Performance Health Center
264 North Main St.
Natick, MA 01760