Facet Joint Pain (Facet Syndrome): Symptoms, Causes & PT Treatment
Updated October 20261 minute read
Facet joints are small joints at the back of your spine that guide movement. When they're irritated or arthritic, you feel localized lower back pain that's typically worse when you lean backward or twist, and better when you bend forward. It's a common, manageable cause of back pain, and physical therapy that restores movement and core control usually helps.
What is facet joint syndrome?
Each spinal level has a pair of facet joints at the back. Like any joint, they can become irritated or develop arthritis, producing pain.
Symptoms
Pain is usually felt across the lower back, sometimes spreading into the buttock or upper thigh. It's classically worse with extension (leaning back), standing, and twisting, and eased by sitting or bending forward. Stiffness after rest is common.
What causes it / risk factors
Age-related joint changes, repetitive extension or rotation (some sports and jobs), and previous injury contribute. It often coexists with disc aging.
How it's diagnosed
A clinician recognizes the movement pattern on exam. Imaging may show arthritis but doesn't confirm it's the pain source, so diagnosis is largely clinical.
Physical therapy treatment
What a PT does. Your therapist reduces the joint irritation, restores comfortable movement, and trains core and hip control to offload the joints. Exercises & progression (overview). Flexion-biased mobility, core stabilization, hip strengthening, and posture/movement retraining. Recovery timeline. Many flares ease within a few weeks with consistent work.
Treatment options compared
PT is first-line. Medication and, in select stubborn cases, targeted injections may help. Surgery is rarely indicated.
Red flags
Seek care for leg weakness, groin numbness, loss of bladder/bowel control, fever, or unexplained weight loss.
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Frequently asked questions
Extension compresses the facet joints; if they're irritated, that position flares the pain.
Sources (5)
- Perolat R, et al. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging. 2018. — PubMed
- George SZ, et al. Interventions for the management of acute and chronic low back pain: revision 2021. Clinical practice guideline. J Orthop Sports Phys Ther. 2021. — PubMed
- Qaseem A, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017. — PubMed
- Hayden JA, et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021. — Cochrane
- Saragiotto BT, et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev. 2016. — Cochrane
This article is for education only and isn't medical advice. Always talk to a licensed clinician about your specific situation.