Facet Joint Back Pain & Facet Arthropathy | Physio Penrith

Facet arthropathy is a term used to describe degenerative changes affecting the small joints at the back of the spine, known as the facet joints. In the lower back, these are called the lumbar facet joints.

If you have had an X-ray, CT or MRI, your report may use terms such as facet arthropathy, facet joint arthritis, facet degeneration, facet osteoarthritis or lumbar spondylosis.

These findings can sound concerning, but an important point is that facet joint changes on a scan do not automatically mean the facet joint is causing your back pain. Degenerative changes become increasingly common with age and can also be found in people without symptoms.

At Sydney Muscle & Joint Physio Penrith, we assess the whole clinical picture rather than treating an imaging report alone. Our goal is to understand how your back pain is affecting your movement, work, exercise and everyday activities and develop an individual rehabilitation program to help you get moving again.

What Is Facet Arthropathy?

Facet joints are small joints located on either side of the spine. They help guide movement between adjacent vertebrae and contribute to the load-bearing function of the spine.

Like other joints in the body, facet joints can develop age-related structural changes.

These may include:

• narrowing of the joint space
• changes to the joint surfaces
• osteophyte formation
• subchondral changes
• enlargement or hypertrophy of the joint

Collectively, these changes may be described as facet arthropathy or facet joint osteoarthritis.

However, identifying facet arthropathy on imaging is different from establishing that the facet joint is responsible for someone’s pain.

Does Facet Arthropathy Always Cause Back Pain?

No.

This is one of the most important things to understand if your scan mentions facet arthropathy.

Changes such as facet joint arthritis, disc degeneration, disc bulges and other degenerative findings can occur in people who have no low back pain.

Therefore, an MRI showing facet arthropathy does not necessarily explain why your back hurts.

Imaging findings need to be interpreted alongside your:

• symptoms
• medical history
• physical examination
• neurological examination where appropriate
• functional limitations
• response to movement and activity

Our aim is therefore not simply to “treat the scan”.

Instead, we assess the person in front of us and determine which factors may be contributing to their pain and loss of function.

What Does Facet Joint Back Pain Feel Like?

There is no single symptom or physical test that can definitively diagnose facet-mediated low back pain.

However, people thought to have facet-related pain may report symptoms such as:

• pain around one or both sides of the lower back
• localised aching or stiffness
• pain around the buttock
• pain that may spread into the thigh
• symptoms aggravated by certain movements or activities
• discomfort with prolonged standing or walking
• pain with movements involving lumbar extension or rotation

These features are not specific to facet joint pain and can occur with other types of low back pain.

This is why symptoms alone should not be used to confidently label the facet joint as the source of someone’s pain.

Can Facet Joint Pain Cause Referred Pain?

Low back pain can sometimes be accompanied by symptoms away from the lumbar spine.

For example, some people experience pain around the:

• buttock
• hip
• groin
• thigh

This is sometimes described as referred pain.

Referred pain does not necessarily mean that a nerve is compressed or damaged.

If your main symptom is pain spreading from your lower back into your buttock or thigh without neurological symptoms, you may also find our information on Low Back Pain with Referred Pain helpful.

Facet Joint Pain vs Sciatica: What’s the Difference?

Facet-related or referred back pain should not automatically be described as sciatica.

Referred Back Pain

Referred pain may spread from the lower back into areas such as the buttock or thigh without evidence of spinal nerve-root dysfunction.

It may feel like a dull, deep or diffuse ache.

Sciatica and Radicular Pain

Sciatica is commonly used to describe nerve-related pain travelling from the lower back or buttock into the leg.

Radicular pain may feel:

• shooting
• burning
• electric
• sharp
• radiating

It may also be associated with pins and needles or numbness.

Lumbar Radiculopathy

Radiculopathy refers more specifically to neurological impairment associated with dysfunction of a spinal nerve root.

This can cause:

• muscle weakness
• altered sensation
• numbness
• changes in reflexes

Facet joint enlargement or other degenerative changes can sometimes contribute to narrowing around a spinal nerve. However, this is a different clinical presentation from uncomplicated facet arthropathy.

If you are experiencing significant leg pain, numbness, pins and needles or weakness, see our Low Back Pain with Sciatica page for more information.

How Is Facet Joint Back Pain Diagnosed?

Diagnosing facet-mediated pain is not always straightforward.

There is no single movement, symptom or routine physical test that can conclusively demonstrate that a facet joint is responsible for someone’s pain.

Your physiotherapy assessment is therefore designed to understand your overall presentation.

This may include asking about:

• how and when your symptoms started
• the location of your pain
• whether symptoms spread into your buttock or leg
• movements that aggravate or relieve symptoms
• sitting, standing and walking tolerance
• work demands
• exercise and sporting activities
• previous episodes of back pain
• previous treatment
• general health
• your goals for rehabilitation

Your physical examination may assess lumbar and hip movement, strength, functional tasks and how your symptoms respond to different movements and loads.

If you have leg symptoms, we may also assess neurological function, including strength, sensation and reflexes where clinically indicated.

The aim is not necessarily to identify one painful structure. It is to develop a useful clinical picture that helps guide treatment.

What About the Kemp or Extension-Rotation Test?

You may have read that extending and rotating your lower back can be used to diagnose facet joint pain.

Although this movement can reproduce symptoms in some people with low back pain, pain during extension and rotation is not enough to confirm that the facet joint is the source of pain.

Other structures and presentations can also be sensitive to these movements.

For this reason, we do not base your diagnosis or treatment plan on one provocative test.

Do I Need an MRI or X-Ray for Facet Arthropathy?

Usually not simply because you have low back pain.

Routine imaging is generally not recommended for uncomplicated low back pain when there are no clinical features suggesting a specific or serious condition.

This is particularly important with facet arthropathy because degenerative facet-joint changes can be present in people who do not have pain.

Imaging can be useful when there is a specific clinical question, signs suggesting a condition requiring further investigation or when the result is likely to change management.

If you already have an MRI, CT or X-ray showing facet arthropathy, we can help explain those findings in the context of your symptoms and physical examination.

Physiotherapy Treatment for Facet Arthropathy and Back Pain

Treatment should be based on your overall low back pain presentation rather than the presence of facet arthropathy on a scan alone.

At Sydney Muscle & Joint Physio Penrith, we favour an active, evidence-based approach.

Depending on your presentation, treatment may involve education, exercise, strength training, gradually increasing activity and strategies to help you return to work, exercise or sport.

Education and Understanding Your Scan

If you have been told you have “arthritis in your spine”, it is understandable to worry that movement could cause further damage.

However, structural changes on imaging do not necessarily mean your back is fragile.

An important part of treatment is explaining your scan in context and helping you understand what you can safely do.

Our aim is to reduce unnecessary fear of movement and help you gradually return to normal activity.

Staying Active

Complete rest is generally not recommended for uncomplicated low back pain.

Instead, we usually encourage people to continue normal activities as much as reasonably possible.

If a particular activity significantly aggravates your symptoms, it may initially need to be modified.

This could involve temporarily changing:

• training volume
• lifting loads
• walking distance
• prolonged standing
• repetitive bending
• work demands

The aim is usually to modify and progressively rebuild, rather than permanently avoid movement.

Exercise for Facet Arthropathy Back Pain

There is no single “facet joint exercise” that works for everyone.

Your exercise program should be based on your individual symptoms, goals and physical capacity.

Rehabilitation may include:

• lumbar movement exercises
• trunk strengthening
• hip and lower-limb strengthening
• progressive resistance training
• aerobic exercise
• walking
• graded lifting
• work-specific conditioning
• gym-based rehabilitation
• return-to-running or sport exercises

Rather than simply avoiding movements that hurt, rehabilitation may gradually expose you to movements and loads that you need for everyday life.

The goal is to improve your overall physical capacity and confidence.

Do I Need to Avoid Back Extension?

Not necessarily.

Some people with low back pain find extension uncomfortable during a flare-up, but that does not automatically mean extension is damaging their facet joints.

If a particular movement is highly provocative, we may temporarily modify how frequently or intensely you perform it.

As symptoms improve, movement can often be gradually reintroduced.

Our goal is generally not to create permanent movement restrictions unless there is a specific medical reason to do so.

What About Manual Therapy?

Manual therapy may provide short-term improvements in symptoms or movement for some people.

However, we generally use manual therapy as an adjunct to active rehabilitation, rather than as the main treatment for facet arthropathy or low back pain.

If manual therapy helps you move more comfortably, we can use that opportunity to progress your exercise and normal activities.

The longer-term goal is to improve your ability to independently manage your back rather than becoming reliant on repeated passive treatment.

What About Injections and Radiofrequency Treatment?

Most people with low back pain should begin with appropriate non-surgical management.

For persistent, localised low back pain that has not responded adequately to conservative management, some people may be referred to a pain specialist or spinal specialist for further assessment.

In carefully selected patients where pain is suspected to originate from structures supplied by the medial branch nerves, diagnostic medial branch blocks may be considered.

A positive response to an appropriately performed diagnostic block may help determine whether a person is suitable for procedures such as radiofrequency denervation.

These interventions are not required simply because an MRI shows facet arthropathy.

Your GP or specialist can advise whether further investigation or interventional pain management is appropriate for your particular presentation.

When Should Back Pain Be Investigated Further?

Most low back pain is not caused by serious disease.

However, some presentations require further medical assessment.

Seek urgent medical attention for symptoms such as:

• new bladder or bowel dysfunction
• numbness around the saddle or genital region
• significant or rapidly worsening leg weakness
• major trauma
• significant unexplained systemic illness
• fever associated with concerning back symptoms
• other significant neurological changes

Your physiotherapist will screen for clinical features that may require medical referral during your assessment.

Facet Joint Back Pain Physio Penrith

If you’ve been told that you have facet arthropathy, facet joint arthritis or degenerative changes in your lower back, it can be difficult to know what you should and shouldn’t do.

At Sydney Muscle & Joint Physio Penrith, we take an evidence-based approach to low back pain.

We don’t simply treat an MRI or X-ray finding.

Instead, we assess your symptoms, movement, strength, physical capacity and the activities that are important to you.

Your rehabilitation may include:

• education about your condition and imaging findings
• advice about staying active
• individualised exercise
• progressive strength training
• improving general physical activity
• graded exposure to painful or difficult movements
• work-specific rehabilitation
• return-to-gym or sport rehabilitation
• strategies for managing flare-ups
• manual therapy where appropriate as an adjunct

Our goal is not simply to temporarily reduce your symptoms. We want to help you move confidently, improve your physical capacity and return to the activities that matter to you. For the evidence that supports our philosophy, the Australian Low Back Pain Clinical Care Standard specifically advises clinicians to explain that facet joint arthritis and other degenerative findings are common in people without pain, and that imaging is usually unnecessary without an appropriate clinical indication. NICE similarly recommends self-management, continued normal activity and exercise, with manual therapy considered only as part of a package that includes exercise. 

If low back pain or a diagnosis of facet arthropathy is affecting your work, exercise or everyday life, book an appointment with our Penrith physiotherapists for an individual assessment and rehabilitation plan.