Facet arthritis in the low back

Facet arthritis affects the small joints at the back of the lumbar spine. It is a common source of axial low back pain that can refer into the buttock without true sciatica.

What it feels like

People describe a deep, one-sided or bilateral ache in the low back that worsens with standing, extension, or twisting.

Pain may travel into the buttock or posterior hip, but it usually does not shoot past the knee in a classic nerve-root pattern.

Morning stiffness and relief with supported sitting or gentle flexion are common themes.

What is going on

Lumbar facet joints carry load with extension and rotation. Over time they can develop cartilage wear, inflammation, and bony overgrowth.

Pain signals travel through the medial branch nerves. That anatomy is why medial branch blocks are used diagnostically.

MRI or x-ray may show facet arthropathy. Those findings are common with age and must be matched to the clinical pattern.

How we evaluate

We distinguish axial facet-pattern pain from radicular sciatica, stenosis claudication, and sacroiliac patterns.

Exam looks at extension-rotation provocation, neurologic status, and hip contribution.

If facets remain the leading question, a diagnostic medial branch block can confirm or refute that hypothesis.

What we may offer

Movement coaching and physical therapy are often early parts of the plan.

Positive diagnostic medial branch blocks may lead to a discussion of radiofrequency ablation for longer relief.

If leg-dominant nerve pain is present, we shift toward disc or stenosis pathways and may discuss epidural steroid injections.

Is facet arthritis the same as a slipped disc?

No. Facet arthritis involves the small joints behind the disc. Disc problems more often produce radicular leg symptoms when they irritate a nerve root.

Why do a block instead of treating from the MRI alone?

Because facet changes on imaging are common and do not always explain the pain. A block tests whether those joints are actually generating your symptoms.

How long does relief from a medial branch block last?

The diagnostic anesthetic window is hours. Longer relief is the goal of ablation after a convincing diagnostic sequence, not of the test itself.

Can I still exercise with facet pain?

Often yes, with modifications. We keep helpful movement and trim the positions that repeatedly flare the joints.