If your back pain is worse when you lean backwards, stand for a while or twist — and eases when you sit or bend forward — there's a good chance your facet joints are involved. Facet joint syndrome is one of the most common causes of chronic low back pain I treat, and it's also one of the most satisfying, because when it's correctly diagnosed, the results of treatment are often excellent. This is a companion to our main low back pain guide, focused on this one condition.
Facet joint syndrome is back pain from the small facet joints at the back of the spine, typically worse on bending backwards, standing and twisting. It's confirmed with a diagnostic medial branch block and treated for the long term with facet denervation radiofrequency ablation (RFA) — which calms the nerves carrying facet joint pain without weakening the back — alongside physiotherapy. Surgery is not usually needed.
What Are the Facet Joints?
At every level of your spine, in addition to the disc at the front, there are two small joints at the back called facet joints. They guide and limit the movement of the spine — how far you can bend, straighten and twist. Like any joint, they're lined with cartilage and can become worn, inflamed and painful with age, wear or strain (a process sometimes called facet arthropathy). Each facet joint is supplied by tiny nerves called the medial branches, which carry its pain signals.
In plain terms: think of the facet joints as the hinges at the back of the spine's stack of blocks. When a hinge wears and gets irritated, it aches — especially when you load it by leaning back or standing. The clever part of treatment is that we can target the specific little nerve wires (the medial branches) that carry that hinge's pain.
Typical symptoms of facet joint syndrome
- Back pain worse on bending backwards, standing and twisting
- Pain that eases on sitting or bending forwards
- Stiffness, especially in the morning or after rest
- Pain that may spread to the buttock or thigh but usually not below the knee
- Local tenderness over the spine to one or both sides
How Facet Joint Pain Is Diagnosed
This is where interventional pain medicine really shows its value. Facet joint pain often doesn't show clearly on an MRI, and MRIs frequently show facet wear in people with no pain at all. So rather than treating a scan, we test the facet joints directly.
A diagnostic medial branch block is a small, precise, image-guided injection of local anaesthetic onto the medial branch nerves supplying the suspected joints. In plain terms: we temporarily switch off the wires from those specific hinges. If your usual pain largely disappears for the duration of the anaesthetic, we have strong confirmation that those facet joints are the source — and that you're very likely to benefit from denervation RFA.
Facet Denervation Radiofrequency Ablation (RFA)
Once the medial branch block has confirmed the facet joints as the source, facet denervation RFA offers lasting relief.
In plain terms: using image guidance to place the needle precisely on each medial branch nerve, we apply controlled radiofrequency heat to calm those specific pain-carrying nerves — turning down the volume on the pain signal from the worn facet joints. Because these are small sensory nerves, this relieves pain without weakening your back or affecting movement. Relief commonly lasts many months, and because nerves slowly regenerate, the procedure can be safely repeated if the pain returns.
1. Confirm the source
A diagnostic medial branch block confirms the facet joints are causing your pain.
2. Image-guided RFA
Under ultrasound and C-arm guidance, the radiofrequency needle is placed precisely on each medial branch nerve; the area is numbed first.
3. Same-day discharge
The procedure takes about 30–45 minutes and you go home the same day.
4. Rehabilitation
The pain-free window is used for core strengthening and posture work to protect the spine and make relief last.
Facet denervation RFA is done under local anaesthesia; most patients feel pressure rather than pain and go home the same day. Relief commonly lasts several months up to a year or more, and the procedure can be repeated safely if pain returns.
Why Our Approach Is Different
Every facet procedure we perform is image-guided (ultrasound and C-arm) to an international standard, and we always confirm the diagnosis with a medial branch block before denervation — because RFA only works well when the right joints are treated. And every procedure is paired with a structured rehabilitation programme, because a strong, well-supported spine is what keeps the pain from returning.
Image-Guided Precision
Ultrasound and C-arm guidance place the needle exactly on each medial branch nerve.
Confirmed Before Treated
We prove the facet joints are the source with a diagnostic block before offering RFA.
Lasting, Repeatable Relief
Denervation calms only sensory pain nerves; relief lasts months and can be repeated.
Rehabilitation Built In
Core strengthening and posture work make the relief durable.
Doctor's advice
If your back pain fits the facet pattern — worse leaning back, better sitting — ask specifically about a diagnostic medial branch block. It's the honest way to know whether facet denervation RFA will help you, and it spares you from treatments aimed at the wrong target. Then commit to the rehabilitation; that's what turns months of relief into lasting recovery.
Key takeaways
- Facet joint syndrome is a common cause of back pain, typically worse leaning back and better sitting.
- It's confirmed with a diagnostic medial branch block, not just an MRI.
- Facet denervation RFA gives lasting relief without weakening the back.
- Relief lasts months and the procedure can be safely repeated.
- Rehabilitation makes the results durable; surgery is rarely needed.
Summary
Facet joint syndrome is a common and highly treatable cause of chronic low back pain. The key is to confirm it with a diagnostic medial branch block rather than relying on a scan, then treat it for the long term with image-guided facet denervation RFA, paired with core-strengthening rehabilitation. Done this way, most patients get substantial, lasting relief without surgery.
Frequently Asked Questions About Facet Joint Syndrome
What is facet joint syndrome?
Back pain from the small facet joints at the back of the spine, typically worse on bending backwards, standing and twisting, and better on sitting.
How is facet joint pain diagnosed?
With a diagnostic medial branch block — a precise, image-guided injection that temporarily numbs the nerves supplying the facet joints. Good relief confirms the source.
What is facet denervation RFA?
A procedure using controlled heat to calm the medial branch nerves carrying facet joint pain, giving lasting relief without weakening the back.
How long does facet joint RFA last?
Commonly several months up to a year or more. As the nerves slowly regenerate, it can be repeated safely.
Is facet denervation RFA painful?
It's done under local anaesthesia; most patients feel pressure rather than pain and go home the same day.
What is the recovery after facet RFA?
Most people resume light activity within a day or two, with any minor soreness settling over a few days.
Does facet joint syndrome need surgery?
Rarely. It's usually managed with physiotherapy, medial branch blocks and facet denervation RFA. Surgery is not the standard treatment.
Can facet joint pain be cured permanently?
It can be brought under lasting control, especially when RFA is combined with core strengthening. Because nerves regenerate, repeat treatment is sometimes needed.
Is facet RFA safe?
It has a strong safety profile when performed under image guidance. Serious complications are uncommon.
Where can I get facet denervation RFA in Delhi?
At PainClinix, Punjabi Bagh, interventional pain specialist Dr. Titiksha Goyal performs image-guided medial branch blocks and facet denervation RFA for patients across West Delhi and Delhi NCR.
Medical disclaimer
This article is for general education and does not replace a personal medical consultation. Facet joint syndrome should be diagnosed and treated after individual assessment. Please consult a qualified pain physician before making decisions about your care.