What Are Facet Joint Injections, and Do They Work?
A facet joint injection delivers a small amount of local anaesthetic, sometimes mixed with steroid, directly into one of the small joints at the back of the spine. It is used both to confirm whether a facet joint is causing your pain and, in some cases, to provide temporary relief. Injections do not fix the underlying problem, and results vary from person to person.
Key takeaways
- Facet joint injections serve two roles: diagnosis and short-term pain relief.
- A medial branch block targets the tiny nerves that supply the joint, not the joint itself.
- If a diagnostic block works, radiofrequency denervation may offer longer-lasting relief.
- Accurate patient selection matters. Standing, weight-bearing imaging can show facet problems that lying-down scans miss.
- Injections are not a cure. They work best as part of a broader plan that includes physiotherapy.
What is a facet joint injection?
A facet joint injection is an image-guided procedure where a needle is placed into or next to one of the facet joints in your spine. These small paired joints sit at the back of each vertebra and allow your spine to bend and twist. When they become irritated or worn, a condition known as facet joint arthropathy, they can cause localised back or neck pain that is often worse when you lean backwards, twist, or stand for a long time.
The injection usually contains local anaesthetic, and sometimes a corticosteroid to reduce inflammation. It is carried out as a day-case procedure under X-ray or CT guidance so the clinician can see exactly where the needle is going.
What are the different types of facet joint procedure?
There are three main approaches, each with a slightly different purpose. The right one for you depends on whether the goal is diagnosis, short-term relief, or longer-lasting pain management.
Local anaesthetic is injected into the joint. If your pain goes away for a few hours, the facet joint is very likely the source. This is often the first step before any further treatment.
Instead of injecting the joint itself, the anaesthetic targets the medial branch nerves that carry pain signals from the facet joint. This is a more precise diagnostic test and is often required before radiofrequency treatment is approved.
Also called radiofrequency ablation. A heated needle tip is used to disrupt the medial branch nerve so it can no longer send pain signals. Relief typically lasts longer than injections alone, often several months to over a year, though the nerve can regrow.
How long do facet joint injections last?
A diagnostic injection with anaesthetic alone may relieve pain for only a few hours. That short window is the point: it tells the clinician whether the facet joint is the true source of your symptoms.
When steroid is added, some people experience weeks or even a few months of reduced pain and inflammation. Others find little lasting benefit. The evidence on steroid injections for facet joints is mixed, and repeat procedures are common.
Radiofrequency denervation tends to last longer. Published studies suggest many patients get meaningful relief for six to twelve months or more. When the nerve regrows and pain returns, the procedure can usually be repeated.
Why patient selection matters
Facet joint injections are most effective when the clinician is confident the facet joint is genuinely responsible for the pain. That confidence comes from two things: a thorough clinical assessment and the right imaging. If the wrong joint is targeted, or if the real problem lies elsewhere, an injection will not help, regardless of how well it is performed.
This is where the quality of your imaging becomes critical. Wear and tear across multiple spinal levels is common, especially with spondylosis. Standard lying-down scans may not reveal which joints are under the most mechanical stress, because lying down removes the load that provokes your symptoms.
Why does standing imaging matter before a facet joint injection?
Standing, weight-bearing imaging shows your spine the way it actually works: upright, loaded, and subject to gravity. Facet joints are load-bearing structures. When you lie down for a conventional X-ray, CT or MRI, gravity is removed, muscles relax, and the spine settles into a position it never holds during daily life. Alignment shifts that stress certain facet joints may simply disappear on a lying-down scan.
Your body is a connected chain from your feet to your head. A subtle pelvic tilt or leg-length difference can load one side of the spine more than the other, overworking certain facet joints. ScanAlign, weight-bearing standing imaging captures the entire skeleton in one upright scan, using about 90% less radiation than a standard X-ray, around ten times less. That full-body view helps identify the mechanical cause of facet overload, not just the joint that hurts.
If you are considering facet joint injections and want to understand the alignment behind your pain, a standing spine scan can provide vital context before you commit to a procedure.
Book a free video consultationWho is a good candidate for facet joint injections?
Good candidates are people whose pain pattern strongly suggests facet involvement and whose imaging supports that conclusion. Injections work best when they are part of a broader management plan, not a standalone fix.
- Pain mainly in the back or neck that worsens leaning backwards or twisting
- Localised tenderness over the facet joints
- Imaging that shows facet arthropathy at a specific level
- Symptoms that have not improved with physiotherapy and simple painkillers alone
- Pain that radiates strongly down the leg (may be a disc or nerve root issue)
- Widespread pain without a clear mechanical pattern
- No supporting imaging evidence of facet joint wear
- Expectation of a permanent cure from a single injection
When MRI is the better tool. EOS and standing X-ray show bones, joints and whole-body alignment brilliantly. But if your clinician suspects a disc bulge, nerve compression, or soft-tissue inflammation, MRI is usually the better choice for those structures. The two types of imaging complement each other.
A note on urgent symptoms
If you experience sudden numbness in your legs, weakness that is getting worse, or any loss of bladder or bowel control, do not wait for an injection or a scan. Contact your GP, call 111, or go to A&E straight away. These symptoms need urgent medical attention.
What does facet joint injection recovery look like?
Recovery from a facet joint injection is usually quick. Most people leave the clinic within an hour and can return to normal activities within a day or two. You may feel some soreness around the injection site for a short while.
After a diagnostic block, your clinician will ask you to keep a pain diary for a few hours, noting what changed and when. This feedback helps decide whether the targeted joint is genuinely the source of your pain.
Physiotherapy alongside injections is often recommended. The injection can create a window of reduced pain that lets you engage more fully with strengthening and mobility exercises. Without that rehabilitation work, pain is more likely to return once the injection wears off.
Frequently asked questions about facet joint injections
Most people describe a brief sting and a deep pressure sensation. Local anaesthetic is used to numb the skin first. The procedure is usually over in a few minutes and is well tolerated.
A diagnostic block lasts a few hours. A steroid injection may provide relief for weeks to a few months. Radiofrequency denervation often lasts several months to over a year, though individual results vary.
A facet injection goes into the joint capsule. A medial branch block targets the small nerves that supply the joint. Both are diagnostic, but medial branch blocks are generally considered more precise and are usually required before radiofrequency denervation.
Yes, facet joint injections and medial branch blocks are available through the NHS, though waiting times can vary. Your GP or a spinal specialist can refer you.
Serious complications are rare. The main risks include temporary soreness at the injection site, infection, and a short-term increase in pain. Your clinician will discuss specific risks with you beforehand.
You typically need a referral from a GP or specialist for the injection itself. However, you can self-refer for a standing spine scan at ScanAlign to help clarify the picture before you see a specialist. You can book a standing spine scan without a referral.
Steroid injections reduce inflammation around the joint. Radiofrequency denervation uses heat to interrupt the nerve that carries pain signals. Denervation tends to give longer-lasting relief and does not rely on anti-inflammatory medication.
Facet joints are load-bearing. When you lie down, gravity is removed and the joints decompress. Alignment shifts and uneven loading that stress certain facet joints in daily life may not appear on a lying-down MRI or CT. Standing imaging captures your spine under its normal working load.
Yes. An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. It captures your full skeleton in a single standing image with a very low dose.
You can find full pricing details on the ScanAlign FAQs and pricing page.
Understand your alignment before your next procedure
A standing whole-body scan can show whether alignment or compensation is loading your facet joints unevenly. Talk to us for free before you commit to treatment.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- NICE Clinical Knowledge Summaries. Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59, 2016 (updated 2020).
- Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020;45(6):424-467.
- Royal College of Radiologists. iRefer: Making the best use of clinical radiology. RCR guidelines for imaging referral.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.