Facet joint dysfunction is inflammation or mechanical irritation of the small paired joints that sit behind each vertebra in your spine. It produces a distinctive one-sided ache that sharpens when you arch backwards or twist, and it’s one of the most common causes of axial back and neck pain that chiropractors, physiotherapists, and osteopaths treat at Costa Health on the Costa del Sol.
What exactly are facet joints, and why do they go wrong?
Each spinal segment has two facet joints, sometimes called zygapophyseal joints. They guide movement and share load with the disc in front. Trouble starts when the cartilage lining wears thin, when a sudden awkward movement jams the joint, or when a neighbouring disc loses height and shifts extra force onto the facets.
Age is the single biggest risk factor. A 2020 systematic review in The Spine Journal found radiographic facet joint osteoarthritis in roughly 60% of adults over 60, though many of those people had no symptoms at all. That gap between imaging findings and actual pain matters clinically, because it means an MRI alone can’t diagnose facet dysfunction. The diagnosis is made through a careful physical examination, not a scan.
Occupational loading plays a role too. Paul Morrison, chiropractor at Costa Health, spent more than 15 years in manual trades before retraining. He sees the pattern regularly: bricklayers, painters, warehouse staff, and golf enthusiasts who’ve loaded their lumbar facets asymmetrically for years.
How can you tell it’s a facet problem rather than a disc?
Facet pain and disc pain overlap enough to confuse even experienced clinicians, but a few features point strongly towards the facets. Pain that stays within a hand’s width of the midline and worsens with backward bending (extension) is classic. Rolling over in bed at night often catches people off guard. The pain rarely travels below the knee, which helps distinguish it from sciatica.
A common misconception is that facet dysfunction always shows up on imaging. In fact, studies published in Pain Medicine have shown that diagnostic facet blocks, where a small volume of local anaesthetic is injected into the joint under imaging guidance, remain the reference standard. Many patients with entirely normal X-rays have painful facets, and many with dramatic-looking facet arthritis on MRI have no pain at all.
One edge case worth knowing: facet cysts. When a facet joint degenerates severely it can produce a fluid-filled synovial cyst that bulges into the spinal canal. This rare complication can mimic a disc herniation and occasionally requires surgical excision.
What does treatment at Costa Health look like?
Costa Health takes a multidisciplinary approach. No single profession owns facet joint dysfunction, and patients tend to respond best when treatment is matched to their presentation rather than shoehorned into one discipline.
Chiropractic spinal manipulation is often the first-line manual option. A targeted high-velocity, low-amplitude thrust can restore segmental motion and reduce pain quickly. For patients who prefer a gentler approach, osteopathic mobilisation techniques work the same joints through graded, rhythmic movements without the audible cavitation.
Physiotherapy comes into its own for the rehabilitation phase. Strengthening the deep spinal stabilisers, particularly multifidus and transversus abdominis, gives the facet joints long-term mechanical support. Research in the British Journal of Sports Medicine (2021) confirmed that targeted motor control exercise significantly reduces recurrence in people with chronic low back pain.
Sports massage addresses the protective muscle guarding that almost always accompanies facet irritation. The paraspinal muscles lock up as a reflex, and releasing that tension often produces immediate relief.
When should you worry about facet joint pain?
Most facet dysfunction settles within weeks with appropriate manual therapy and exercise. But certain red flags demand urgent medical assessment.
Bilateral leg weakness, bladder or bowel changes, or saddle-area numbness suggest cauda equina syndrome and require same-day evaluation at A&E, regardless of what you think is causing your back pain. Progressive unrelenting night pain that doesn’t respond to position changes warrants investigation to rule out sinister pathology.
For the vast majority of people, though, facet joint dysfunction is a mechanical problem with a mechanical solution. Getting an accurate clinical assessment early prevents the cycle of pain, guarding, deconditioning, and more pain that so many patients fall into.
Can you prevent facet joint problems?
Prevention isn’t always possible, especially when age-related degeneration is the driver. But two things make a measurable difference. Maintaining a strong, well-conditioned trunk reduces the load each facet joint has to absorb. And avoiding sustained end-range extension, like sleeping face-down or spending hours painting a ceiling, removes the single most provocative position for irritable facets.
If you’re living on the Costa del Sol and dealing with a stiff, aching back that flares up when you lean backwards, book an assessment at Costa Health. Paul Morrison and the wider clinical team can pinpoint whether your facets are the source of the problem and build a treatment plan around your specific needs.