Facet Joint Arthropathy: What Is It and Why Does Your Back Feel So Stiff?
Facet joint arthropathy is wear and tear of the small joints that link each vertebra in your spine. It causes stiffness, aching and sometimes sharp pain. This is most often in the lower back or neck. Symptoms tend to be worse when you arch backwards, twist, or stand for a long time. It is one of the most common causes of ongoing back pain in adults.
Key Takeaways
- Facet joints are small paired joints at the back of each spinal segment. They guide movement and bear load.
- Arthropathy here means the cartilage wears down over time. This causes inflammation, stiffness and pain.
- Lying-down scans can miss the way load affects these joints. Standing imaging shows your spine under real weight.
- Pain from facet joints often appears away from the actual problem, because of how the spine compensates.
- ScanAlign is a diagnostic imaging clinic. It does not treat facet joint arthropathy, but its imaging helps clinicians plan the right next steps.
You have two facet joints at every level of your spine, one on each side. They sit just behind the main disc. They act like hinges and guide how far you can bend and twist. When the cartilage inside these joints wears thin, the joint surfaces rub together. The bone may thicken (a process sometimes called facet hypertrophy), and the tissues around it become inflamed. This is facet joint arthropathy.
It is basically the same process as arthritis in a knee or hip, just in a much smaller joint. The lumbar spine (lower back) is the area most often affected, followed by the cervical spine (neck). It can happen at one level or at several.
What does facet joint arthropathy feel like?
Facet joint pain is usually a deep, dull ache on one or both sides of the spine. It is often worse first thing in the morning or after sitting for a long time. It tends to ease with gentle movement. It comes back with long periods of standing or with arching backwards.
A dull, deep pain close to the spine, often on one side of the lower back or neck.
The back feels locked up after sleep or sitting, then loosens once you start moving.
Arching backwards or twisting loads the facet joints directly. This often triggers a sharp catch.
Lumbar facet problems can send pain into the buttock or thigh. Cervical facet pain may spread across the shoulder or up to the head.
A note on nerve symptoms. Facet joint arthropathy does not usually cause numbness, tingling, or weakness in the legs. If you have any of these, or any loss of bladder or bowel control, please get urgent medical help from your doctor or your nearest emergency department. These could signal a different, more serious problem.
What causes facet joint arthropathy?
The main driver is load that builds up over years. The more stress a facet joint bears, the faster the cartilage wears. Several things increase that stress.
Cartilage thins naturally over decades. Most people over 50 show some facet changes on imaging.
Extra weight increases the compressive force through the lumbar facet joints with every step.
A pelvic tilt, scoliosis, or uneven leg length can overload one side of the spine more than the other.
When a disc loses height, the facet joints above and below have to take more of the load.
This is where the compensation chain matters. Your body is one connected structure from feet to head. If one area is out of line, the spine adjusts somewhere else. For example, a subtle pelvic tilt may overload the facet joints on one side of the lumbar spine for years before pain appears. The pain shows up in the facet joint, but the real driver is the alignment problem below.
How is facet joint arthropathy assessed when standing?
A standing, weight-bearing image shows your spine the way it actually works: under the pull of gravity, with your muscles active. Lying-down scans (standard X-rays, CT, MRI) let your muscles relax. This can flatten curves and hide the alignment shifts that are overloading your facet joints in daily life.
An EOS scan captures your entire skeleton from head to feet in a single standing image, using about 90% less radiation than a standard X-ray, around ten times less. The whole body is in one frame. So a specialist can trace the alignment chain and see whether a pelvic tilt, a leg-length difference, or a shift in your spinal balance is putting extra stress on certain facet joints.
This matters because treating a painful facet joint without understanding why it is overloaded often gives only short-term relief. The imaging does not replace treatment. It gives your treating clinician the full picture, so they can target the underlying cause, not just the symptom.
Wondering whether your back pain could be linked to whole-body alignment? A free video consultation can help you decide if standing imaging is a useful next step before you plan a trip to London.
Book a free video consultationWhen MRI is the better choice. EOS shows bones, joints and alignment clearly. For soft tissue problems like disc bulges, nerve compression or inflammation inside the facet joint itself, MRI is usually the better tool. In many cases, the two types of imaging work well together.
What helps manage facet joint arthropathy?
Management depends on how severe it is and on the underlying cause. Your doctor, physiotherapist or spine specialist will suggest options based on your own situation. Common approaches include the following.
- Physiotherapy and exercise. Strengthening the core and improving how well the spine moves are usually the first steps. A programme tailored to your alignment findings can be more effective than a general routine.
- Activity modification. Avoiding long periods of arching, or heavy lifting overhead, may reduce flare-ups.
- Pain management. This can range from simple over-the-counter options to facet joint injections guided by imaging, depending on what your clinician recommends.
- Addressing the alignment cause. If a pelvic tilt, scoliosis or leg-length difference is driving the overload, correcting it (sometimes with something as simple as a shoe insert) can reduce ongoing wear.
Before you start a treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in your pelvis, your legs or your spine changes what will actually help.
ScanAlign does not provide any of these treatments. It provides the diagnostic imaging that helps your treating clinician understand the full alignment picture and choose the right approach. You can learn more about how standing spinal imaging works on our spine page.
Frequently asked questions about facet joint arthropathy
It is arthritis of the small hinge joints at the back of each spinal segment. The cartilage inside the joint wears down over time. This causes stiffness, inflammation and pain. It is very common and most often affects the lower back.
Most people describe a dull ache close to the spine, sometimes on one side. It is usually worse when arching backwards, twisting, or standing for a long time. It tends to ease with gentle movement. Pain may spread into the buttock, thigh, or shoulder, depending on which level is affected.
Facet hypertrophy means the joint has enlarged, usually because the bone has thickened in response to extra stress. It is one feature of facet joint arthropathy. Facet joint arthropathy is the broader term that covers cartilage loss, inflammation and bony changes.
Lumbar facet problems can refer pain into the buttock and the back of the thigh. But they do not usually cause true nerve pain below the knee, numbness or weakness. If you have those symptoms, see your doctor promptly, as there may be a different cause.
An MRI gives excellent detail of the soft tissues inside and around the joint. A standing scan shows how the joint behaves under your body weight, with gravity pulling on the spine. The two serve different purposes. A standing EOS scan is especially useful for showing alignment problems that overload the joint, which a lying-down MRI cannot show.
Yes. EOS uses about 90% less radiation than a standard X-ray, around ten times less. You can find more detail on safety, preparation and what to expect on our FAQs page.
No. ScanAlign is a self-referral clinic. You can book directly without a referral letter from your doctor. The scan is a private, self-pay service.
The price for patients travelling from abroad is confirmed during the free video consultation, and you can find more detail on our FAQs page.
It can progress, especially if the underlying mechanical cause is not addressed. This is why understanding your full spinal and pelvic alignment matters. Targeted management based on good imaging can slow the process and reduce symptoms.
Disc problems affect the soft cushion between the main bodies of the vertebrae. Facet joint arthropathy affects the smaller joints at the back of the spine. The two conditions are often present together, because a worn disc shifts load onto the facet joints. The pain patterns differ too: disc pain is usually worse when bending forward, while facet pain is usually worse when arching backwards.
Find out what is driving your facet joint pain
A free video consultation with our specialist radiographer can help you understand whether standing whole-body imaging is the right next step for you, before you travel to London.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Kalichman, L. & Hunter, D.J. (2007). Lumbar Facet Joint Osteoarthritis: A Review. Seminars in Arthritis and Rheumatism, 37(2), 69-80.
- NHS. (2023). Back pain: Causes. NHS.uk. Available at: nhs.uk/conditions/back-pain.
- Illés, T. & Somoskeöy, S. (2012). The EOS imaging system and its uses in daily orthopaedic practice. International Orthopaedics, 36(7), 1395-1402.
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.