Ep. 30 Facet Joint Low Back Pain: What It Is, Why It Happens & How to Rebuild Your Back

Facet joint low back pain is common, but it is often poorly understood and easily oversimplified.

In this episode, we explain what the lumbar facet joints actually do, how they can become sensitive, and why repeated extension and compression can be a common aggravating factor.

We also discuss how previous disc changes may alter the way load is shared through the spine and potentially increase the demand placed on the facet joints.

From there, we cover the common signs of facet-dominant back pain, including:

• Localised or one-sided low back pain
• Pain aggravated by standing, walking or arching backwards
• Symptoms that tend to ease with sitting, flexion or unloading
• Mechanical symptoms that change predictably with movement and posture

We also explore why MRI findings such as facet arthritis or degeneration do not automatically mean that the facet joint is the source of pain. These changes are common, particularly as we age, so imaging always needs to be interpreted alongside the person’s symptoms, movement behaviour and clinical assessment.

The episode also challenges some common misconceptions, including the idea that facet arthritis means inevitable decline, that the back simply needs more stretching, or that injections are the only option.

Finally, we break down the rehabilitation process from identifying and reducing aggravating movements, to improving spine hygiene, walking tolerance, spinal endurance, movement proficiency and gradually rebuilding load capacity.

The key message is that facet joint pain does not necessarily mean your spine is worn out or damaged beyond repair.

In many cases, understanding the movements and loads that aggravate the joint and then progressively improving the spine’s ability to tolerate them, is far more useful than simply focusing on what appears on a scan.

If you’ve been told you have facet arthritis or facet degeneration and are unsure what that actually means, this episode will give you a much clearer framework for understanding the condition and how rehabilitation can help.