When most people think of arthritis, they picture knees or hands — not the small, paired joints running down the back of the spine. But facet joint syndrome, a form of arthritis affecting these joints, is one of the most under-recognized causes of chronic back pain, and it’s one Dr. Jeff Hall and the team at Chattanooga Non-Surgical Orthopedics diagnose and treat regularly.

What Are Facet Joints, and Why Do They Hurt?

Facet joints are the small, cartilage-lined joints located on the back of each vertebra, where one vertebra connects to the next. Working in pairs at every spinal level, they guide and limit motion — allowing you to bend, twist, and extend your spine without the vertebrae grinding against each other.

Like any joint in the body, facet joints can develop osteoarthritis over time, as the cartilage lining wears down and the joint surfaces begin to rub directly against one another. This is often accelerated by:

• Age-related “wear and tear” degeneration
• Disc height loss, which shifts more load onto the facet joints (a close relationship with degenerative disc disease)
• Prior injury or repetitive spinal extension (common in gymnasts, golfers, and certain manual labor jobs)
• Poor posture, which can create uneven, chronic loading on specific facet joints

The Telltale Signs of Facet Joint Pain

Facet joint syndrome tends to have a fairly recognizable pattern: a dull, aching pain localized to one or both sides of the spine, often worse with backward bending (extension) or prolonged standing, and typically better when sitting or bending forward — nearly the opposite pattern from spinal stenosis. Pain may also refer into the buttock or upper thigh, which sometimes leads to it being confused with sciatica, even though the underlying mechanism is completely different.

Because facet-related pain doesn’t always show up dramatically on standard imaging, it’s frequently underdiagnosed — patients are told their X-ray or MRI looks “unremarkable,” when in reality, the joint’s biomechanical dysfunction simply isn’t always visible on a static image. A skilled hands-on exam is often what actually identifies it.

How CNS Orthopedics Treats Facet Joint Syndrome

Chiropractic Adjustments — Precise spinal adjustments restore normal motion and alignment to the affected facet joints, reducing abnormal loading and irritation. This is frequently the first-line treatment for facet-related pain.

Shockwave Therapy — Acoustic wave therapy stimulates cellular repair and breaks down the chronic inflammatory cycle in and around irritated joints and surrounding soft tissue. We’ve covered the science behind Shockwave therapy in more depth here for patients curious how it works at the cellular level.

Prolotherapy — This regenerative injection technique strengthens the ligaments supporting the facet joints, improving joint stability and reducing the excess motion that often drives facet pain.

Low Level Laser Therapy — Helps calm local inflammation in and around arthritic facet joints, often used alongside adjustments and Shockwave for a layered treatment approach.

Clinical Exercise — Strengthening the core and hip muscles takes mechanical stress off the facet joints, which is essential for keeping pain from returning once you’ve found relief.

Facet Pain Is Treatable — Even If Your Imaging Looked “Normal”

If you’ve been told your imaging is unremarkable but you’re still dealing with a nagging, localized ache in your back — especially one that worsens when you arch or stand for long periods — facet joint syndrome may be the missing piece. Dr. Hall’s thorough hands-on evaluation is designed to catch exactly this kind of diagnosis.