What Are Facet Joints?
Every vertebra in the spine — from the cervical to the lumbar region — connects to the vertebrae above and below it through two small joints called facet joints (also called zygapophyseal joints, or Z-joints). These joints guide and limit spinal movement, bearing approximately 20% of the compressive load on the spine in normal posture. Like any joint in the body, they are lined with cartilage, enclosed in a joint capsule, lubricated with synovial fluid, and densely innervated with pain-sensitive nerves.
When facet joints become arthritic, inflamed, or dysfunctional — a condition called facet syndrome or facet joint syndrome — they can become a primary source of back and neck pain that is often mistaken for disc-related pain.
What Causes Facet Syndrome?
- Degenerative arthritis (osteoarthritis) — the most common cause in patients over 50; cartilage breakdown leads to bone-on-bone friction and osteophyte (bone spur) formation
- Acute injury — hyperextension injuries, whiplash, and falls can acutely sprain the facet joint capsule
- Chronic postural loading — prolonged sitting with poor posture, excessive lumbar lordosis, or repetitive extension movements increase facet loading
- Secondary to disc degeneration — when a disc loses height, the facet joints above and below that level are forced to bear more load
Identifying Facet Pain
Facet syndrome has several characteristic features that distinguish it from disc-related pain:
- Worse with extension (bending backward) and rotation — these movements compress the facet joints
- Relieved by flexion (bending forward) — this unloads the facets
- Worse in the morning after being stationary, then improves with movement
- Localized paravertebral tenderness — pain felt on pressing the muscles just beside the spine
- Referred pain patterns — lumbar facet joints refer pain to the buttocks, hips, and thighs; cervical facets refer to the head, neck, and between the shoulder blades
Facet vs. disc: Disc pain is generally worse with flexion (bending forward) and sitting. Facet pain is generally worse with extension and standing. If your back feels better when you bend forward or sit, facet syndrome is likely. If sitting makes it worse, the disc is more likely the source.
Treatment at Pittsburgh Physical Medicine
Spinal Manipulation
Chiropractic adjustment directly targets the dysfunctional facet joint, restoring normal joint motion, reducing capsular inflammation, and normalizing the mechanoreceptor signals from the joint. It is consistently the most effective short-term treatment for acute facet-related pain.
Cox Flexion-Distraction
For facet syndrome accompanied by spinal stenosis or in patients who cannot tolerate traditional manipulation, Cox Flexion-Distraction gently decompresses the facet joints and restores mobility without high-velocity forces.
Physical Therapy
Postural retraining, core stabilization, and mobility work address the underlying mechanical factors that overload the facet joints. Strengthening the deep stabilizers of the spine reduces chronic facet joint stress.
Soft Tissue Work
The multifidus and other paraspinal muscles surrounding painful facet joints invariably develop protective spasm. Massage therapy and Graston technique address the muscular component of facet pain.
Suffering from Facet Syndrome?
Our team at Pittsburgh Physical Medicine treats this condition with chiropractic care, physical therapy, and soft tissue techniques — under one roof in East Liberty, Pittsburgh.
Book an Appointment →