Pain Worse with Extension or Rotation: Understanding Facet Joint Pain

If your low back pain increases when standing, leaning back, or twisting, the culprit may be your facet joints small stabilizing joints on the back of your spine that allow motion and prevent over-rotation. When they degenerate or become inflamed, they can cause deep, aching pain that mimics disc or muscle problems.

How Facet Joint Pain Feels

  • Dull ache or stiffness in the lower back

  • Pain worse when leaning back or twisting

  • Pain relieved by sitting or bending forward

  • Local tenderness over the spine

Common Causes

  • Arthritis or wear-and-tear (spondylosis)

  • Previous injury or repetitive stress

  • Poor posture or deconditioning

  • Degenerative Disc Disease shifting pressure onto joints

Diagnosis

Facet pain can’t be confirmed on imaging alone it requires diagnostic medial branch nerve blocks, performed under X-ray or ultrasound guidance.

  • X-ray or MRI: to evaluate structural changes

  • Medial Branch Block: numbs the small nerves that transmit pain signals If relief follows, the diagnosis is confirmed.

Diagnosis

Facet pain can’t be confirmed on imaging alone it requires diagnostic medial branch nerve blocks, performed under X-ray or ultrasound guidance.

  • X-ray or MRI: to evaluate structural changes

  • Medial Branch Block: numbs the small nerves that transmit pain signals If relief follows, the diagnosis is confirmed.

Treatment Options

Facet Joint Injection

Delivers medication or orthobiologic material into the joint.

Radiofrequency Ablation (RFA)

Heats and deactivates the medial branch nerves, providing relief that can last 6–12 months.

PRP or BMAC Therapy

Regenerates and stabilizes facet joints naturally.

Low Back Frequently Asked Questions

01. What is a facet ablation (RFA), and how is it different from diagnostic blocks?

Answer: Blocks test the pain source; ablation stops the nerve signal.
A medial branch block temporarily numbs a spinal joint to confirm the pain generator. If it works, radiofrequency ablation (RFA) uses heat to deactivate that small nerve for 6–12 months. The joint stays stable, and pain often lessens dramatically.
Lumbar | Interventional Spine | RFA

02. How long does a radiofrequency ablation (RFA) last, and can it be repeated?

Answer: Relief often lasts 6–12 months and the procedure can be repeated safely.
After an RFA, the tiny sensory nerves that send pain signals grow back slowly. Many patients enjoy meaningful relief for 6 months to a year. If the pain returns, a repeat ablation can usually be performed using the same approach. Regular stretching and strengthening help extend the benefit. Lumbar | Cervical | Interventional Spine | RFA

03. Why does my low back hurt after sitting or long drives?

Answer: It’s usually from facet-joint stress or weak postural muscles.
Sitting flexes the lumbar spine and compresses facet joints and discs, especially if the core is de-conditioned. Over time, this posture leads to inflammation and stiffness. Supportive cushions, regular breaks, and targeted therapy for core and glute muscles often relieve symptoms.
Lumbar | Ergonomics | Rehab

04. What is a diagnostic discogram, and why is it rarely done now?

Answer: It injects dye into spinal discs to find the pain source but carries risks.
Discography involves pressurizing discs with contrast dye while monitoring pain response. It was once common before spine surgery but is now less used because it can worsen disc damage and cause infection. Modern MRI and targeted nerve blocks provide safer diagnostic insight.

Diagnostics | Lumbar | Interventional Spine

05. Why do some people have chronic back pain even after “successful” fusion surgery?

Answer: Adjacent levels often wear out faster.
Spinal fusion stabilizes one level but transfers stress to the discs and joints above and below, leading to adjacent segment disease. Scar tissue, muscle atrophy, and nerve irritation can also persist. Nonsurgical options like PRP or radiofrequency treatment can help preserve the surrounding spine.
Lumbar | Post-Surgery | Interventional Spine

06. What are “adjacent segment disease” and “hardware failure” after spine surgery?

Answer: They mean nearby levels or implants break down over time.
After fusion, joints next to the fused area compensate by moving more, sometimes developing arthritis or stress fractures. Hardware fatigue or loosening can also occur years later. Regular imaging helps detect changes early; pain-management injections or strengthening programs can often delay revision surgery.
Lumbar | Cervical | Post-Surgery | Spine Degeneration

07. How do you tell if leg pain is from the back or from a knee or hip problem?

Answer: Back-related pain travels below the knee; joint pain usually stays local.
Nerve compression in the spine typically causes sharp, shooting pain that radiates past the knee or into the foot. Hip or knee arthritis usually creates aching localized pain or stiffness without tingling. Imaging and physical-exam maneuvers help determine whether the source is spinal, joint, or both.
Diagnostics | Lumbar | Hip | Knee

08. What is an epidural steroid injection and what does it do?

Answer: It delivers anti-inflammatory medicine around pinched nerves.
Guided by X-ray, a thin needle places medication into the epidural space of the spine. The steroid reduces swelling around irritated nerves from a herniated disc or arthritis. Relief may last weeks to months and can allow better participation in physical therapy.
Interventional Spine | Epidural | Lumbar | Cervical

09. What are red-flag symptoms that spine pain is not just mechanical?

Answer: Fever, unexplained weight loss, numbness, or bladder issues.
Warning signs include constant pain at rest, night sweats, progressive weakness, loss of control of urine or stool, or recent infection. These could signal infection, tumor, or severe nerve compression and need emergency evaluation.
Safety | Lumbar | Cervical | Emergency

10. How long should I wait before considering spine surgery?

Answer: Only after conservative care has clearly failed and red flags are excluded.
Most mechanical back or neck pain improves with guided injections, therapy, or biologic repair within 3–6 months. Surgery is reserved for progressive weakness, structural instability, or nerve compression causing loss of function. A second opinion is always appropriate before proceeding.
Lumbar | Cervical | Surgery Decision

11. What is a “facet joint,” and why can it cause back or neck pain?

Answer: It’s a small stabilizing joint behind each vertebra that can become arthritic.
Facet joints allow bending and twisting. With aging or injury, they may develop arthritis and inflammation that causes sharp localized pain, often worse when leaning backward or standing long periods. Facet injections or RFA can calm these joints for months at a time.
Lumbar | Cervical | Anatomy | Interventional Spine

12. When should I seek emergency care after a neck or back injury?

Answer: Sudden weakness, numbness, fever, or bladder/bowel changes.
Go to the ER immediately for severe pain with loss of strength, incontinence, high fever, or trauma with head injury. These could indicate nerve or spinal-cord compression, infection, or fracture. Early treatment prevents permanent damage.
Cervical | Lumbar | Emergency | Safety

13. What is a “nerve root block,” and how is it different from an epidural?

Answer: A nerve-root block targets one specific nerve, while an epidural bathes several.

A selective nerve-root block (SNRB) uses live X-ray to deliver medication directly around one irritated spinal nerve. It helps confirm which nerve causes the pain and can calm inflammation at that precise level. Epidural injections are broader, covering multiple nerves at once.

Interventional Spine | Diagnostics | Lumbar | Cervical

14. How can I tell if my hip pain is coming from the joint or my back?

Answer: Hip arthritis hurts in the groin; back problems radiate to the leg.
Hip joint disease often causes deep aching in the groin or front thigh, worse with walking or stairs. Lumbar nerve compression tends to cause burning or tingling down the leg. Diagnostic injections into the hip or spine can confirm the true source.
Hip | Lumbar | Diagnostics | Joint Pain

15. Can regenerative medicine help spine patients who already have hardware or fusions?

Answer: Yes, but injections are placed around not into the fused levels.
PRP and bone-marrow concentrate can reduce inflammation in joints and ligaments next to a fusion where new pain develops. These procedures don’t interact with the hardware itself. Most patients benefit from improved flexibility and less reliance on pain medication.

Spine | Post-Surgery | Orthobiologics | Interventional Spine

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If your pain worsens when standing, twisting, or leaning back, facet joints may be the cause. Our specialists offer targeted, image-guided treatments to restore movement and reduce pain.

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