By Dr Lewis Kingsnorth DC MChiro, Doctor of Chiropractic · GCC Reg. 3359 · Chiropractic First, Hove
Published 10 November 2026 · Last reviewed 10 November 2026
If your lower back aches on one side when you lean backwards, feels stiff first thing in the morning, or catches when you twist to reach for the seatbelt, you may have heard the term facet joint pain. It’s one of the most common explanations given for mechanical back and neck pain, and also one of the most misunderstood.
In this guide I’ll explain what the facet joints are, the symptom patterns that tend to point towards them, why scans are often less helpful than people expect, and what the current evidence says about treatment, including where chiropractic care fits in.
- The facet joints are small paired joints at the back of each spinal level that guide and limit movement.
- Research suggests they are the main source of pain in roughly 15-45% of people with persistent low back pain, depending on the study and age group.3
- Typical features include a one-sided ache that’s worse leaning back or twisting, stiffness after rest, and pain that may spread into the buttock or thigh but usually not below the knee.
- No single examination test or scan can confirm a facet joint as the source of pain, so assessment focuses on your history, how you move and ruling out other causes.
- Chiropractic care can help with back pain and mechanical neck pain. NICE recommends manual therapy for low back pain only as part of a package that includes exercise, and that’s how we approach it.1
- Some symptoms need urgent medical attention. See the warning-signs section below.
What are the facet joints?
Each vertebra in your spine connects to the ones above and below at three points: the disc at the front, and a pair of small joints at the back, one on the left and one on the right. These back joints are the facet joints. Their anatomical name is the zygapophyseal joints.
Like your knuckles or knees, facet joints are synovial joints. The joint surfaces are lined with smooth cartilage, enclosed in a capsule and lubricated by joint fluid. Their job is to guide the direction your spine moves and stop it moving too far, particularly when you bend backwards, twist or side-bend. They also share some of the load when you stand upright.
Each facet joint has its own nerve supply from small nerves called the medial branches. That’s why the joints and the tissues around them can be a genuine source of pain, and why that pain can be felt some distance from the joint itself.
What is facet joint pain (or “facet joint syndrome”)?
Facet joint pain simply means pain that’s thought to be coming from one or more of these joints. You may see it described in a few different ways:
- Facet joint syndrome: a clinical label for a recognisable pattern of back or neck pain linked to the facet joints.
- Facet arthropathy or facet joint arthritis: age-related changes in the joint, usually seen on a scan.
- A “locked” or “stuck” facet: an everyday term for a sudden, sharp episode of pain and stiffness, often after an awkward movement.
That last phrase deserves a quick reality check. The joint isn’t literally locked or “out of place”. What usually happens is that an irritated joint and the surrounding tissues become sensitive, and the muscles around them tighten protectively to limit movement. It can be intensely painful and alarming, but it’s usually a short-lived episode rather than a sign of structural damage.
Facet joint pain symptoms
In the lower back (lumbar facet joints)
- An ache on one or both sides of the lower spine, often in a fairly specific spot
- Pain that’s worse arching backwards, twisting or side-bending, such as reaching up to a high shelf or turning to look over your shoulder while reversing
- Stiffness after rest, for example first thing in the morning or after sitting, which eases as you get moving
- Discomfort standing still or walking for long periods, sometimes eased by sitting or leaning forwards
- Pain that spreads into the buttock, hip, groin or back of the thigh, usually stopping above the knee3
- Tenderness when pressure is applied over the affected area
In the neck (cervical facet joints)
- One-sided neck ache and stiffness
- Pain turning your head, for example checking a blind spot, or looking up
- Pain spreading to the top of the shoulder or between the shoulder blades
- Headaches felt at the back of the head when the upper neck joints are involved, known as cervicogenic headache
Facet joint pain or a trapped nerve?
| Feature | More typical of facet joint pain | More typical of nerve-related pain (e.g. sciatica) |
|---|---|---|
| Where it’s felt | Back or neck, buttock, thigh; usually above the knee | Often below the knee into the calf or foot (or down the arm, from the neck) |
| Type of pain | Deep, dull ache, with a sharp catch on certain movements | Sharp, burning, shooting or electric |
| Pins and needles or numbness | Not usually | Common |
| Weakness | No | Sometimes |
| Movements that aggravate it | Leaning back, twisting, standing still | Varies; often sitting, bending, coughing or sneezing |
These are general patterns, not a self-diagnosis tool. Symptoms often overlap, and more than one structure can be involved. A proper assessment is the best way to find out what’s going on. If you’re getting tingling in your hands, read our guide to pins and needles in the hands; for leg symptoms, see our guide to sciatica.
What causes facet joint pain?
There’s rarely a single cause. Factors that commonly play a part include:
- Awkward or unaccustomed movement: a sudden bend-and-twist, a weekend of gardening or DIY, or a new activity your back isn’t yet conditioned for.
- Sustained positions: long spells standing still, or holding an arched posture, load the facet joints.
- Age-related changes: facet joints change with age, like other joints. These changes are very common on scans, including in people with no pain at all.
- Changes elsewhere in the spinal segment: the disc and facet joints work as a unit, so a reduction in disc height can change how load passes through the facets.
- General fitness and strength: reduced conditioning can leave the spine less tolerant of everyday loads.
How is facet joint pain diagnosed?
This surprises many people: there is no single physical test, and no scan, that can reliably prove a facet joint is the source of pain. Research reviews consistently report a poor match between symptoms, examination findings and degenerative changes seen on imaging.3 A good assessment therefore focuses on three things:
- Your history: where you feel the pain, how it started, what eases and aggravates it, and your general health.
- A physical and neurological examination: how your spine moves, which movements reproduce your familiar pain, and checks of reflexes, sensation and strength to see whether a nerve is involved.
- Screening for anything that needs a different route: signs of a fracture, infection, inflammatory arthritis or other serious problem mean referral to your GP or hospital rather than chiropractic treatment.
Do you need an X-ray or MRI?
Usually not. NICE advises against routinely offering imaging for low back pain in a non-specialist setting, and says imaging shouldn’t be used as a prerequisite for specialist facet joint procedures either.1
Chiropractic First has digital X-ray on site, but we use it selectively. Every exposure must be clinically justified under the Ionising Radiation (Medical Exposure) Regulations 2017,5 so we only X-ray when the findings warrant it and the result is likely to change how we manage your care, for example to rule out a fracture or other structural problem. An X-ray cannot “see” facet joint pain, and we won’t take one routinely. You can read more about our approach in our guide to chiropractic for back pain.
The specialist test
In specialist pain clinics, the most reliable way to confirm facet joint pain is a diagnostic medial branch block: a procedure that temporarily numbs the small nerves supplying the joint to see whether the pain settles.3 It’s reserved for people with persistent, moderate-to-severe back pain who are being considered for radiofrequency denervation (see below).
Facet joint pain treatment: what does the evidence support?
For most people, facet-related back and neck pain is managed conservatively, without procedures, and the core ingredients are well established.
Staying active and understanding your pain
NICE recommends giving people clear information about their back pain and encouraging them to carry on with normal activities as far as possible.1 Long periods of rest tend to make stiffness worse.
Exercise
Exercise sits at the centre of NICE’s recommendations for low back pain.1 The best exercise is the one you’ll actually do. For facet-related pain it often includes mobility work, trunk and hip strengthening, and gradually rebuilding tolerance to the movements that currently hurt.
Manual therapy as part of a package
NICE recommends considering manual therapy, meaning spinal manipulation, mobilisation or soft tissue techniques such as massage, for low back pain, but only as part of a treatment package that includes exercise.1 That combined approach is how we work. NICE’s guideline covers the lower back specifically; for mechanical neck pain the same principles of keeping moving and building strength and mobility apply.
What NICE doesn’t recommend
NICE advises against traction, and against back belts or corsets, for managing low back pain.1
When conservative care isn’t enough
If back pain persists despite a good course of non-surgical care, your GP can refer you for a specialist opinion. NICE does not recommend spinal injections, including facet joint injections, for managing low back pain.1,2 For a smaller group of people with long-standing, moderate-to-severe back pain thought to come from the facet joints, NICE suggests considering referral for radiofrequency denervation: a procedure that uses heat to switch off the small nerves supplying the joint, offered only after a positive diagnostic medial branch block.1 It’s a specialist pain-clinic procedure, and something we can discuss with you and your GP where appropriate.
How chiropractic care can help with facet joint pain
Chiropractic care can help with back pain and mechanical neck pain, and pain thought to come from the facet joints is a common type of mechanical spinal pain. At Chiropractic First, care typically includes:
- A thorough first assessment: history, orthopaedic and neurological examination, and screening for warning signs. If anything suggests your pain needs a different route, we’ll tell you and refer you on.
- A clear explanation: what we think is driving your pain, what the realistic outlook is, and what you can do yourself.
- Hands-on treatment: which may include spinal manipulation (adjustment), mobilisation and soft tissue techniques, chosen to suit you and your preferences.
- A specific exercise plan: mobility and strengthening exercises to build your tolerance for everyday activity, which NICE regards as essential alongside manual therapy.
- Practical advice: on activity, pacing, desk set-up, driving, lifting and sport.
- Regular reviews: we check progress against your goals. If you’re not improving as expected, we change the plan or refer you to your GP.
What about the “click”?
The popping sound you sometimes hear during spinal manipulation is gas being released within the joint fluid, a process called cavitation. It isn’t a bone “going back into place”, and treatment doesn’t need to produce a click to be worthwhile. If you’d prefer not to have manipulation, gentler mobilisation and soft tissue approaches are always an option.
Is it safe?
Spinal manipulation carried out by a registered chiropractor is generally regarded as a low-risk treatment. The most common side effect is temporary soreness or stiffness for a day or two afterwards. Serious complications are rare. We explain the benefits, risks and alternatives before any treatment so you can make an informed choice: that’s a requirement of our registration with the General Chiropractic Council, and simply good practice.
What you can do at home
While you’re waiting for an appointment, or alongside treatment, these steps are sensible for most people with facet-related back or neck pain:
- Keep moving. Gentle, regular movement is usually better than resting for long periods. Short walks are a good place to start.
- Change position often. Facet-related pain tends to dislike staying in one position, especially standing still. Set a reminder to get up from your desk every 30-45 minutes.
- Try heat or cold. Many people find a warm pack eases stiffness; others prefer a cold pack in the first day or two. Use whichever feels better, wrapped in a towel, for up to 20 minutes at a time.
- Go easy on arching backwards for now. You don’t need to avoid it forever, but limit sustained overhead work or leaning back while things settle.
- Gentle mobility. Lying on your back with your knees bent and slowly rocking them from side to side, or a gentle knees-to-chest stretch, are often comfortable. Stop if an exercise causes sharp pain or brings on leg or arm symptoms.
- Sleep comfortably. On your side with a pillow between your knees, or on your back with a pillow under your knees, often suits a sore lower back. For the neck, choose a pillow that keeps your head level with your spine.
When to seek urgent medical help
Most back and neck pain isn’t serious, but some symptoms need urgent assessment. Don’t wait for a chiropractic appointment.
Call 999 or go to A&E immediately if you have back pain with any of the following. They can be signs of cauda equina syndrome, which needs emergency treatment:
- Numbness or tingling around your genitals or bottom (the “saddle” area)
- New difficulty passing urine, loss of bladder control, or not being able to tell when your bladder is full
- Loss of bowel control
- Numbness, tingling or weakness in both legs, or walking problems that are getting worse
Also call 999 if neck pain comes with a sudden, severe headache or signs of a stroke, such as a drooping face, arm weakness or slurred speech.
See your GP urgently or call NHS 111 if you have back or neck pain with:
- A high temperature, or feeling generally unwell
- Unexplained weight loss
- A history of cancer
- Pain that started after a significant fall, accident or injury
- Pain that’s constant, steadily worsening, or severe at night whatever position you’re in
- Swelling or a change in the shape of your back
- Clumsy hands, or problems with balance or walking, alongside neck pain
Facet joint pain assessment in Hove
Chiropractic First has been looking after back and neck pain in Hove since 2006. We’re at 82 Goldstone Villas, Hove, BN3 3RU, a short walk from Hove railway station, and see patients from across Hove, Brighton, Portslade and Shoreham.
- Early starts and evening appointments: from 6:45am on Mondays, Tuesdays, Thursdays and Fridays, and until 8pm on Mondays and Thursdays
- On-site digital X-ray, used only when clinically justified
- Massage therapy in the same clinic, for soft tissue care alongside chiropractic treatment
- Recognised by AXA and Vitality health insurance (check your policy for cover)
- Online booking at any time
Book a facet joint pain assessment
If one-sided back or neck pain is getting in the way of your day, book an assessment with Dr Lewis Kingsnorth. We’ll find out what’s driving your pain, explain your options clearly and agree a plan, or point you in the right direction if chiropractic care isn’t the right fit.
Call 01273 324466
Frequently Asked Questions
Can a chiropractor help with facet joint pain?
What is a ‘locked’ facet joint?
How long does facet joint pain last?
What should I avoid with facet joint pain?
References
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). nice.org.uk/guidance/ng59
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s quality standard (QS155), statement 6: spinal injections. nice.org.uk/guidance/qs155
- Perolat R, Kastler A, et al. Facet joint syndrome: from diagnosis to interventional management. Insights into Imaging. 2018;9(5):773-789. doi:10.1007/s13244-018-0638-x
- Bogduk N, MacVicar J. Osteoarthritis of zygapophysial joints as a cause of back pain and neck pain: a scoping review. Pain Medicine. 2024. doi:10.1093/pm/pnae036
- The Ionising Radiation (Medical Exposure) Regulations 2017 (SI 2017/1322).
Disclaimer: This article is for general information only and isn’t a substitute for an individual assessment. If you’re worried about your symptoms, speak to a registered healthcare professional. Chiropractic First doesn’t provide emergency care; in an emergency, call 999. “Dr” is a courtesy title used by chiropractors registered with the General Chiropractic Council; Dr Kingsnorth is a chiropractor, not a registered medical practitioner.