Lumbar Facet Joints: The Cause Of Lower Back Pain Explained

The facet joints of the lower back are two small joints that are on the back portion of the vertebral unit, for some with lower back pain, these are often touted as the cause of their pain, which gives rise to a number of interventions and recommendations progressing to procedures like facet joint injections to reduce the pain in the region. Today, we’ll explore the role that facet joints play in a lower back injury, and the resultant symptoms, as there are notable differences in many cases between an aggravated facet joint and an aggravated disc. In spite of this difference, we will see how the relationship the facet joints have to their surrounding structures makes for a more simple approach to resolution and recovery from back pain.

Understand your lower back facet joints

The facet joints in your lower back are two small joints that could be considered similar to many other joints in the body, the finger joints, the elbow, or ankle. There are two cartilage surfaces with a joint space filled with synovial fluid to keep the joints healthy and lubricated. The whole thing is encased in a synovial membrane, which secretes the fluid, as well; as a joint capsule. This is understandably very different to the disc on the front, and as a general rule, these joints are responsible for bearing about 15% of the bodyweight in the standing position each, with the disc on the front bearing about 70%. 

When you bend forwards, you’ll typically move the two joint surfaces away from one another and when you bend backwards, lock the joints in place. Bending and twisting will have the similar effect, bending or twisting one way will lock up facets on the one side, and relatively space out the other side. This becomes relevant when we think of the sharp pain so often reproducible upon twisting and backward bending movements. 

It is important to understand that in the normal healthy spine, the facet joints are perfectly capable of partaking in full ranges of motion without trouble, just like the discs. Movements which focus pressure through one “quadrant” of the back, will invariably focus stresses onto specific facet joints, compressing them. In other instances, there will be a stretch of the facet capsule and synovial capsule as the joints are pulled apart, for example, bending forwards will stretch the capsular ligaments of both facets equally. Bending forwards and to the left will maximally stretch the capsule of the right facet joint. 

Your facet joints do not exist in a vacuum

Following on from the last example, if we explore the movement just described, we can see a movement that is so commonly the root cause of a disc herniation, bending down and twisting to the one side. We see that the same movements that stretch and strain the back portion of your disc also affect the back portion of the facet joint’s capsule too. This is stated to draw out an incredibly important reality. 

No one joint or part is ever left to carry out a movement. We only separate these structures for academic purposes.

Trying to provide solutions in such isolated or disconnected hypothetical environments is why so many struggle. 

The simple truth is that your facet is going to function synergistically with your spinal disc. Degradation or injury to one, will mean that the other has to take the slack. For example, if a team of 4 are carrying a heavy object and one slips and lets go, all of a sudden, the other 3 have to accommodate an additional 25% load split 3 ways. That’s not too bad in a balanced scenario, because it only means a modest increase for each of the 3 team mates. However, backs do not go when we’re just standing still and upright, weight bearing evenly.

A better example, might be a team of 4 moving a fridge down a flight of stairs, the two on the bottom carry significantly more load than the two on the top, if one of the team on the bottom fails, more or less all the load will be transferred to the other team mate at the bottom, possibly beyond what he can bear. In this example, both the first failing party, the one who dropped the load and the one that had to bear a sudden load are damaged or compromised in some way. Often resulting in the whole thing ending up in a heap on the floor.

This is the reality of more or less all injuries to the lower back. This is why the facets will to some degree play a role in the pain you experience in many cases, regardless of a more formal facet diagnosis. 

How your facet joints cause back pain

There are a number of different ways in which the facet joints in the lower back can contribute to your lower back pain. It is often in two main ways, directly and indirectly.

Direct lumbar facet joint pain

When you have the facet joint directly generating pain, the pain is very frequently characterised as sharp and shooting. It might radiate out to one side, or be localised, but it is always on the same side. Comparing this to disc injuries which can result in pain in a variety of regions including the fact that an L4/L5 disc injury on the left could give pain in the region over the L5/S1 region on the right. This is by virtue of the nerves that receive sensory information from the discs. 

Thankfully if you “catch” your left L4/5 facet joint you’re going to experience sharp pain on that left hand side at the level, very commonly it will be associated with a movement that compresses the facet joint, for example, a rotation or a bending to one side, or a arching motion. A great example of a very provocative movement might be if you were sitting at dinner in a restaurant, and turn over your left shoulder to talk to the waiter who’s standing taking your order. This movement would involve you twisting to the left, bending to the left AND arching your back a little, which would almost certainly result in a provocation of the left sided facet joint in the lower lumbar spine. Let alone if the movement was done suddenly. 

Indirect lumbar facet joint pain

This secondary cause results in an easy confusion. In a case where there is also facet degenerative change, osteoarthritis, and there is an injury to the facet joint, it is common that the swelling that builds up in the area can lead to pressure being put on the nerves that are in the immediate vicinity. This would have a similar characteristic to symptoms typically thought of as coming from a disc bulge or herniation. This could happen, and often does, in a “healthy” but injured facet joint, just because of the sheer scale of inflammatory reaction in a confined space, as frequently discussed in other episodes. The reason this is more common in the degenerative spine, is because of the additional complicating factor of spinal stenosis. By definition, if there is bony hypertrophy, a feature that is observed where the joints enlarge as a result of consistent increased irritation and unfair loading, there will be an erosion of the space the nerves have to pass by. Therefore it will require a less severe inflammatory reaction to fill the smaller space and irritate the contents.

This is why symptoms of sciatica, and the dull aching or pressure in the region can also be present, and frequently are. 

A new way of thinking about your back pain

Hopefully you’re beginning to see that although the facet joint might be your “diagnosis” this is too simple an understanding. Facet joints will always become at risk of aggravation in instances of disc herniation, because any injury to the disc, the facet or the mesh of other ligaments in the region leads to instability of the segment. The whole thing is more vulnerable, the interaction between the L4 and L5 vertebrae has been compromised. In the example earlier of the team of 4, they are a team, when one fails the others are all compromised in some way. The sudden change in disc height observed from a disc herniation or bulge, or the damage to the spinal ligaments of the segment change the tension on the rest of the joint. This often gives rise to unbridled movements, such as shearing, which nearly always lead to the aggravation of facet joints at the most inopportune moments.

Examples such as turning around in the kitchen to pick up the kettle, getting up off a chair to stand straight, getting in or out of the car with the instability that results from injury to the segment will expose the facets to uncontrolled movement . When they are aggravated, you will find out about it immediately, with a sharp local pain and sometimes residual aching that comes on later as the inflammatory reaction takes place. 

Knowing that back pain is caused by a back weakness that often is the result of numerous structures failing together, the specific “first domino” to fall is somewhat irrelevant. Sheer happenstance is all that dictates whether it was this structure or that, and thankfully in the low back, there are only so many structures that can fail, we have the disc, the facet joints and the ligaments in between – that’s it, aside from the bones themselves which thankfully are much less common participants. 

This massively simplifies the approach moving forwards, rebuilding stability to the back.

Just like all other joints that become injured, post injury, we simply need to carefully restore stability and integrity to the region. This happens to be a region we cannot clearly see, and is somewhat abstract when comparing it to a knee, ankle or wrist.

Action: recovering from a facet joint injury in the low back

Hopefully you have a better understanding of how facet joint injuries feed into lower back pain. The lightbulbs should have gone off. Chasing specific exercises for your facet joint pain is a waste of time and will only drive you round in circles. Understanding movements that are likely to aggravate the facet joints in specific is helpful, so you can avoid extreme movements into twisting and backward bending. But this should be the case regardless of which injury you have in the early days of recovery. Building stability is vital, and uncontrolled spinal movements have the potential to aggravate the vulnerability. 

Stop making the problem worse

We’re taught not to pick the scab, the same is true here, start out by stopping unnecessary aggravations, things which move the segment of the low back, particularly into ranges of motion previously discussed. You’re going to get small movements occurring from daily life and moving around even if you try to brace yourself until you’re blue in the face, but these movements and undulations are small and actually helpful, such as when walking with good posture. Forcing large range movements commonly recommended, such as knee hugs and knee rocks or child’s pose are unwise and have no place in your recovery.

Start learning spinal control

Too many of us have not devoted adequate attention to how we move and our own physical structure, most jump into exercise without a tutorial. With every facet of life, literally everything you do, you’ve been taught by someone who’s more experienced or educated in the matter, from driving, to your job, and even learning basic mathematics in school. Yet you’ve very rarely been taught how to move and control your own body. It might sound simplistic and of course you can get away with many things prior to injury, but once you’ve been injured, acknowledgement that there is an optimal path, is important and working to learn this path and implement it can work wonders. 

Simple skills of being able to engage and brace your core correctly, without just straining. Learning movement skills for example a squatting motion or hip hinge, and developing the ability to do these in ways that delay spinal involvement is essential. These skills make sure that you can partake in daily life with minimal risk of the lower back being unduly exposed, particularly in the short term.

It is uncontrolled spinal movement at the root of all of your lower back injuries and flare ups, recognition of this fact is essential.

Rebuild tolerance and resilience for the long term

A strong back requires more force to overwhelm it, the same is true for a knee, hip or ankle, even a building for that matter. The commitment to become stronger than you currently are through comprehensive resistance exercises done consistently over the long term will give you what you want. A back that is no longer vulnerable and painful.

You massively decrease the risk of injury, and increase the durability of your back.

This effect extends to your whole body! The only problem is that it requires sacrifice. It requires you to do the work at a time where you feel far from 100%, it requires you to keep it up when you feel like not doing things and when other, more enjoyable options are available. People typically get derailed when the facet joint pain is not there. The prospect of spending 30 minutes or so doing some hard work is easily put to one side in favour of all the things you enjoy that you’ve been missing out on because of the pain. 

Do not let this happen to you!

Rebuilding your back is simple, but consistency is hard because it requires discipline. All of us will falter as we are only human, all of us. But when we do, have a stern but encouraging word with yourself to get back to it, and continue to build the strength in your lower back. This is what will protect your facet joint injury and your back in general, allowing it to heal, remodel and strengthen its resilience to future trauma and failure. If you need help with a program to follow that will take out the guesswork and support you throughout your own journey, you can learn more about the membership to Back In Shape below.