Disclaimer: This article is for general educational purposes only and does not constitute medical advice. Always consult a qualified health professional for advice specific to your condition. © 2026 Better Physiotherapy Bundoora.
Facet joint pain accounts for 15–40% of all chronic lower back pain and 36–60% of chronic neck pain. It responds very well to physiotherapy — with manual therapy and targeted exercise producing significant improvement in most patients.
Understanding Facet Joints
The facet joints are paired synovial joints at each spinal level that guide movement and limit excessive rotation and extension. Each joint is lined with cartilage, enclosed in a joint capsule, and innervated by the medial branch of the dorsal ramus — which also supplies the multifidus muscle.
Facet joints degenerate with age, similar to any synovial joint. Trauma, repetitive extension loading (frequent hyperextension in sport or work), and degenerative changes (spondylosis) all contribute to facet pain.
Lumbar Facet Pain
Classic features: one or bilateral lower back pain, worse with extension and rotation, often with a referred pain pattern into the buttock or posterior thigh (but rarely below the knee). Worsens with standing and walking; often relieved by sitting and flexion. Morning stiffness is common.
Cervical Facet Pain
Cervical facet pain is extremely common — particularly at C2/C3 (upper cervical) causing headache, and C5/C6 and C6/C7 (lower cervical) causing neck and arm pain. It is a major contributor to chronic neck pain after whiplash and can be misdiagnosed as radiculopathy.
Physiotherapy Treatment
- Joint mobilisation and manipulation — the most effective treatment for acute facet pain. Grade III–V mobilisation and high-velocity manipulation of the affected spinal segment reduces pain and restores movement rapidly. The Maitland concept and McKenzie approach are commonly used frameworks
- Exercise prescription — lumbar flexion bias exercises (knees to chest, pelvic tilts) off-load the facet joints during the acute phase. As pain settles, progressive core strengthening is introduced
- Postural correction — excessive lumbar lordosis increases facet loading. Addressing anterior pelvic tilt and thoracolumbar extension posture reduces chronic facet stress
- Dry needling — to the multifidus and erector spinae trigger points that develop secondary to facet pain
- Heat therapy — sustained application of heat reduces facet capsule irritation and muscle spasm
Frequently Asked Questions
What does facet joint pain feel like?
Facet joint pain is typically: one-sided (or bilateral) back or neck pain; worse with extension (bending backward), rotation, or sustained standing; relieved with flexion (bending forward) or sitting; may refer into the buttock or thigh for lumbar facets, or into the shoulder and upper arm for cervical facets; does not typically produce neurological symptoms (numbness or tingling) unless adjacent nerve roots are also affected.
Is facet joint pain the same as a "locked back"?
A "locked back" or "facet lock" is an acute episode of facet joint irritation that causes severe, one-sided back pain and muscle spasm — often occurring with an innocuous movement like bending to pick something up. The joint becomes acutely inflamed and the surrounding muscles spasm protectively. Manual therapy (mobilisation or manipulation) is highly effective in the acute phase and often provides dramatic relief within 1–2 sessions.
Will facet joint pain come back after physiotherapy?
Without addressing the underlying factors (poor movement patterns, weak spinal muscles, posture), facet joint pain does tend to recur. The key to long-term management is: progressive strengthening of the spinal stabilisers to offload the facet joints, movement pattern retraining to avoid sustained extension loading, and an ongoing home exercise program. Physiotherapy produces durable results when rehabilitation is completed fully.
What is a facet joint injection and when is it used?
A facet joint injection (cortisone injected into the facet joint or medial branch nerve block) is used when physiotherapy has not produced adequate response, or to confirm the joint is the pain source before considering radiofrequency neurotomy (burning the nerve supply). Physiotherapy is always tried first and should continue after any injection to address the underlying cause.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora