What is a Spinal Facet Syndrome?

Lumbar Facet Syndrome 

Low back pain complaints are the leading cause of disability globally.  

Literature has shown that between 15 and 40% of patients presenting with low back pain will have lumbar facet syndrome.

Some researchers estimate that facet joint syndrome accounts anywhere from 15% of all low back pain complaints to 59.6% in men and 66.7% in women.

Each functional segment between the vertebral bones in the lumbar spine has three joints the intravertebral joint and two facet joints.

The facet joints are the connections between the bones of the spine. The nerve roots pass through these joints to go from the spinal cord to the arms, legs and other parts of the body.

In your spine, the joints connecting each of your vertebrae are known as facet joints.

The disc functions as a spacer and to support motion between the vertebral bodies. This forms a tripod relationship between the intervertebral disc and the facet joint.

Any time either of these joints are injured or degenerated, they immediately impact the other two joints in the tripod.

While facet joint syndrome most often affects the lumbar spine, the cervical and thoracic spinal regions may be affected as well.

Facet joints receive innovation from medial branches of the posterior primary rami, which spans several functional segments.

This means there is overlap in the innervation between the inferior and superior facets to each segment.

Due to this overlap it is thought that this causes the pain experienced from facet syndrome to be localised and one-sided. The facet syndrome occurs when there is compression of one of the nerves which supply of facet joint.

Trauma—like whiplash from a car accident—is a common cause of facet joint syndrome in the neck. While aging is the leading cause of facet joint pain in the lumbar spine, trauma from a sports injury or auto accident can cause chronic low back joint pain too.

Facet joint pain produces different symptoms based on the spinal region affected.


Cervical Facet Joint Syndrome

Facet joint syndrome in the neck can produce neck and shoulder pain that can restrict your range of motion, making it difficult to rotate your head comfortably. Facet joint syndrome in the cervical spine may also cause headaches.

Thoracic Facet Joint Syndrome

Thoracic facet joint syndrome can cause pain in your midback, and you may find your range of motion restricted to the point where you find it necessary to turn your entire body to look over to the right or left.

Lumbar Facet Joint Syndrome

Low back pain is commonly caused by facet joint syndrome. You may feel pain in the lower back and sometimes in the buttocks and/or thighs (the pain usually does not go below the knee). Inflammation of these joints can cause stiffness and difficulty standing up straight and getting up out of a chair. Pain with initiating motion is the most prevalent symptom. The condition may cause you to walk in a hunched over position.


The compression can occur from three primary causes.

  1. Degeneration

Facet degeneration typically begins from a non-specific synovial reaction triggered by trauma, ageing or several other causes.

Degeneration of the underlying hyaline cartilage which covers the facet joint and inflammation of the joint capsule because expansion can lead to a host of painful symptoms.

This can cause narrowing of the surrounding structures like the lateral canal and uncomfortable compression of the nerve.

  1. Osteophytes

Osteophytes are extra bony growth that can occur anywhere in the skeletal system.

When osteophytes form on the facet joint it can cause disruptions in the biomechanics of the joint lead to further compression on the nerves of the functional segment.

  1. Trapped meniscoids

When synovial joints move normally the fibrous cap of the miniscoid separating them can become trapped between the articular surfaces and cause significant discomfort. 


Diagnosing lumbar facet syndrome

Diagnosing the facet syndrome and distinguishing it from other causes of low back pain like a herniated disc or nerve root irritation is often a more complicated task than it would seem. 

The first thing chiropractors aim to determine is that it doesn’t indicate a more serious pathology.

We also need to establish if there are any congenital anomalies exist like facet tropism.

In this common anomaly there is a change in the direction of orientation of the facet joints.

A classic presentation of facet syndrome is usually described by the patient is local to one sided low back pain beginning after a miscalculated simple movement.

Patients may also recall standing up too quickly from being bent over to pick up something or completing an activity like gardening.

They may also complain of pain in the lower extremities including the hip buttock or thigh however not below the knee. 

In summary facet syndrome these findings may include:

  1. absent of neurological deficits
  2. absence of nerve root tension sign all tests
  3. localised pain with camps manoeuvre
  4. pain when reproducing the straight leg raise which does not extend below the knee.


Lumbar facet syndrome treatment

Facet related pain is very responsive to chiropractic care. This is believed to be primarily due to an increasing gapping of the facet joint following a side posture spinal adjusting. This has even been demonstrated on MRI. There’s two theories that explain this the first suggests that a spinal adjustment in the lumbar spine releases an entrapped meniscoid, restoring proper biomechanical movement to the area and reducing the associated pain.

The second theory proposes that improvement in the function of the large fibre input nerves produces modifications in the pain reflects, causing reductions in associated muscle spasms and reflex mediated pain.

Core strengthening exercises can strengthen the spine and reduce the stress on the facet joints. Reducing lumbar lordosis

Therefore it is important to reduce excessive lumbar lordosis with exercise because excessive lordosis increases loading on the posterior aspect of the spine, including the z-joints. To achieve this, the patient should be taught pelvic manoeuvres to reduce the degree of lumbar lordosis. These pelvic tilt exercises can be performed in multiple positions such as sitting, standing with knees bent or straight legs.