Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Back pain is often a mystery to those suffering from it. One day, you feel well, and the next, you notice it is difficult to turn your head or straighten your posture after tying your shoes. Unlike a broken bone, where the cause is obvious, facet joint pain is often the result of a silent, slow progression. It is rarely caused by a single event but rather by a combination of aging, mechanics, and lifestyle. To understand why you need facet denervation, it is helpful to understand how the joints got damaged in the first place.
This section explores the root causes of facet joint syndrome. We will look at the natural aging process of the spine, the impact of old injuries like whiplash, and how your daily posture contributes to the wear and tear. We will also discuss the connection between your discs and your joints, as they work together as a unit. Knowing the causes of the pain can help you understand it and prevent it from worsening.
The most common cause of facet pain is osteoarthritis, also known in the spine as spondylosis. This is the same wear-and-tear arthritis that affects knees and hips. The facet joints are lined with articular cartilage, a slick, rubbery substance that allows the bones to glide smoothly against each other. Over decades of bending, twisting, and lifting, this cartilage begins to thin and fray.
As the cartilage wears away, the protective space between the bones decreases. Eventually, bone begins to rub directly against bone. The body tries to repair this damage by growing new bone, forming bumps called bone spurs or osteophytes. These spurs can irritate the joint capsule and the nearby nerves. The result is inflammation, stiffness, and the deep, aching pain that characterizes facet syndrome. It is a mechanical failure of the joint’s surface.
Aging is the primary factor. Just as our skin wrinkles and our hair grays, our joints dry out. The fluid that lubricates the facet joints decreases with age.
Without adequate lubrication and with thinner cartilage, friction increases. This friction causes the joint to become inflamed. This phenomenon is why stiffness is often worse in the morning; the joints have been still all night and need to “warm up” and obtain fluids moving again.
When the body senses instability or friction in a joint, it tries to stabilize it by laying down more calcium. This creates bone spurs. While the body’s intention is good, the result is often bad.
These spurs enlarge the joint, making it look swollen on an X-ray. These enlarged joints take up more space and can press on nerves. The rough surfaces of the spurs grate against each other with every movement, triggering the pain signals that are detected by the facet denervation X-ray. These.
While aging is the slow cause, trauma is the fast one. This phenomenon is particularly true for the cervical spine (the neck). Whiplash injuries from car accidents are a leading cause of facet joint pain in younger people. In a rear-end collision, the head is snapped backward and then forward with incredible speed.
This violent motion forces the facet joints in the neck to crash together, compressing them far beyond their normal range. This can bruise the cartilage or tear the capsule surrounding the joint. Even if X-rays taken at the emergency room show no broken bones, the microscopic damage to the facet joints can set off a cycle of inflammation that leads to chronic pain months or years later. Sports injuries, such as those from football or gymnastics, can cause similar damage to the lower back through repeated hyperextension (bending backward).
Your daily habits play a massive role in the health of your facet joints. The human spine is designed to be in a neutral alignment, with gentle curves in the neck and lower back. However, modern life often forces us into unnatural positions. Sitting for hours at a computer, hunching over a smartphone, or driving for long periods puts static stress on the spine.
When you slouch or sway your back excessively (swayback), you jam the facet joints together. This is called “facet loading.” If you maintain this position for eight hours a day, you are constantly compressing the cartilage. Over time, this pressure kills the cartilage cells and accelerates arthritis. Poor mechanics when lifting—lifting with your back arched rather than your legs—also places massive shear forces on these small joints, leading to injury.
The spine is a three-legged stool. The large disc is the front leg, and the two facet joints are the back legs. These three structures work together to support your weight. If one fails, the others suffer. Degenerative disc disease is almost always found alongside facet joint arthritis because they are mechanically linked.
When a spinal disc loses water and height due to aging, it shrinks. As the disc collapses, the vertebrae above and below move closer together. This loss of height shifts the weight-bearing load from the disc (which is designed to handle it) to the facet joints (which are not). The facet joints are suddenly forced to carry far more weight than they were built for. This overload causes them to degenerate rapidly. It is rare to see severe facet disease without some degree of disc degeneration.
Imagine a building settling. As the foundation (the disc) sinks, the structures above it shift. As the disc flattens, the facet joints at the spine’s back telescope.
This abnormal overlapping puts stress on the joint capsule. It changes the angle at which the joints move, making them less efficient and causing back spasms.
Normally, the discs carry about 80% of your spinal load, and the facets carry about 20%. When the disc degenerates, that ratio shifts. The facets may end up carrying 50% or more of the load.
This excessive pressure is the mechanical cause of the pain. It is like driving a car with a flat tire; the rim (the facet joint) gets damaged because the tire (the disc) isn’t doing its job.
Some people are simply prone to joint issues due to their DNA. Just as some families have a history of bad knees or hips, some families have a history of spinal arthritis. Genetics can determine the quality of your cartilage and how quickly it breaks down.
Anatomy also plays a role. Some people are born with facet joints that are shaped asymmetrically (tropism), where one side is angled differently than the other. This mechanical imbalance causes the spine to twist slightly with every movement, leading to uneven wear and tear. While you cannot change your genetics, knowing your family history can help you be more proactive about maintaining a healthy weight and staying active.
Some people are simply prone to joint issues due to their DNA. Just as
Regardless of the initial cause—whether it was a car accident 20 years ago or just getting older—the result is a cycle of inflammation. When the joint is irritated, the body releases inflammatory chemicals to try to heal it. These chemicals sensitize the medial branch nerves.
Once sensitized, these nerves begin to fire pain signals even with minor movements. The muscles around the sore joint then tighten up into a spasm to protect it. This spasm compresses the joint further, causing more irritation and more pain. Facet denervation breaks this cycle by stopping the nerve signal, which allows the muscles to relax and breaks the feedback loop of pain.
some families have a history of bad knees or hips, some families have a history of spinal arthritis. Genetics can determine the quality of your cartilage and how quickly it breaks down.
Anatomy also plays a role. Some people are born with facet joints that are shaped asymmetrically (tropism), where one side is angled differently than the other. This mechanical imbalance causes the spine to twist slightly with every movement, leading to uneven wear and tear. While you cannot change your genetics, knowing your family history can help you be more proactive about maintaining a healthy weight and staying active.
Send us all your questions or requests, and our expert team will assist you.
Yes. Lifting heavy objects, especially those with poor form, like arching your back or twisting while lifting, puts immense pressure on the facet joints. These events can cause acute inflammation or tears in the joint capsule.
No. Sciatica is caused by a pinched nerve root and typically shoots down the leg to the foot. Facet pain is usually localized to the back or neck, or it radiates only to the buttocks or thighs (for lower back) or shoulders (for neck). It rarely goes past the knee or elbow.
Yes. Every pound of excess weight, especially around the midsection, pulls the spine forward. This increases the curve of the lower back and jams the facet joints together with greater force, accelerating arthritis.
Yes. Stress causes muscle tension. When you are stressed, you tend to tighten your neck and back muscles. This constant tension compresses the inflamed facet joints, increasing the pain you feel.
It might. Arthritis is a progressive condition. While the pain often fluctuates between good and awful days, the underlying wear and tear generally does not reverse. Treatment helps manage the symptoms so you can remain active, which is key to slowing progression.
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