Facet Joint Pain or Herniated Disc

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Written By Dr. Carlos Roberto Babá

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Facet joint pain and herniated discs are two different conditions that can cause pain and discomfort in the spine. While both conditions can result in similar symptoms, their causes and treatments differ.

Understanding the differences between these two conditions can help determine the appropriate course of action for managing pain and promoting healing.

While MRI results can confirm the presence of a herniated disc, it’s essential to combine this information with a physical examination. A false positive MRI result may lead to incorrect diagnoses and treatments.

Facet Joint Pain

Facet joint pain, as previously discussed, arises from issues with the facet joints, which are small joints located between each vertebra in the spine. These joints help stabilize the spine and facilitate its range of motion. Facet joint pain typically results from inflammation, compression, or subluxation (misalignment) of the joints, often due to muscle tightness or imbalances.

Symptoms of facet joint pain can include localized pain, stiffness, and reduced mobility. Treatment options for facet joint pain often focus on addressing muscle imbalances, reducing inflammation, and promoting joint mobility through physical therapy, gentle exercises, and anti-inflammatory medications.

Symptoms of facet syndrome include:

  • Localized back pain that may refer down the leg but not past the knee
  • Relief when bending forward and discomfort when bending backward
  • No positive orthopedic tests or reflex abnormalities

Herniated Disc

degenerative disc disorder

A herniated disc, also known as a slipped or ruptured disc, occurs when the soft, gel-like center of an intervertebral disc pushes through a tear in the tougher, outer layer of the disc. This can result in pressure on nearby nerves, leading to pain, numbness, and weakness in the affected area.

Herniated discs often occur as a result of age-related degeneration, injury, or repetitive stress on the spine. Symptoms can include pain that radiates along the path of the affected nerve, numbness, tingling, and muscle location of the herniated disc determines the area of the body affected. For instance, a herniated disc in the lower back may cause sciatica, which is characterized by pain radiating down the leg.

Symptoms of disc herniation include:

  • Difficulty bending forward, often unable to touch toes
  • Numbness, tingling, or burning sensations down the leg
  • Positive orthopedic signs, such as loss of reflexes in the leg or a positive straight leg raise test

Treatment options for a herniated disc typically depend on the severity and location of the herniation. Conservative treatment approaches include rest, physical therapy, pain-relieving medications, and anti-inflammatory medications. These treatments aim to alleviate pain, reduce inflammation, and strengthen the muscles that support the spine. In some cases, a herniated disc may require more invasive treatments, such as epidural steroid injections or surgery, especially if conservative treatments fail to provide relief or if neurological symptoms worsen.

Distinguishing Between Facet Joint Pain and Herniated Disc

While both facet joint pain and herniated discs can cause similar symptoms, a thorough examination and diagnostic imaging (such as X-rays, MRI, or CT scans) can help differentiate between the two conditions. A healthcare professional will typically perform a physical examination, review the patient’s medical history, and assess the nature and location of the pain to determine the most likely cause.

It is crucial to obtain an accurate diagnosis to ensure that the appropriate treatment plan is implemented. Misdiagnosing or neglecting one condition for the other may lead to ineffective treatments and prolonged pain or discomfort.

By working closely with a healthcare professional, patients can receive proper guidance and care to address their specific spinal condition and promote healing and recovery.


Exercise is an essential component of managing facet arthritis.

One of the best exercises for facet arthritis or hypertrophy and pain resulting from dysfunction is the following exercise. Get on all fours with your hands right below your shoulders and your knees slightly spread apart. Lean your buttocks back as you sit between your legs. As you go down and come up, put all the motion back into the facet joints. If a facet joint is locked or has scar tissue, this exercise actually opens up those facet joints. This is a great exercise, and you can do 10 to 15 of them per set, a couple of sets at a time. You could bring your head down if it’s a little easier for you. As you look down, you may feel a little more of a stretch. This exercise is very safe for you, but if you have knee problems, this may not be the exercise for you because it may aggravate your knee.

Facet arthritis can also happen in the neck. The head being 12 pounds, and every inch forward results in additional ten pounds of load. This can increase the low to Menace ly, putting excessive wear and tear on these facet joints. Facet arthritis within the neck area is a serious issue, and it can affect the nerve root that’s coming out of that area, causing pain into the arms, chest, inside the shoulder blade, back into the behind the skull, over the head, behind the eyes, and again, it can mimic herniated discs. Therefore, proper diagnosis and diagnosis pertaining to this condition are essential.


chronic pain relax

There are several treatment options available for facet joint syndrome or herniated disc pain. Conservative treatments, such as exercise and physical therapy, can help manage the pain and improve mobility.

Anti-inflammatory medications and muscle relaxants may also be prescribed to manage pain and muscle spasms.

If conservative treatments fail to alleviate symptoms, more invasive treatments may be necessary. One option is facet joint injections, which involve injecting a combination of a local anesthetic and steroid into the facet joint. This can provide pain relief for several months. Radiofrequency ablation is another option, which involves using heat to destroy the sensory nerves supplying the facet joint. This can provide pain relief for up to a year.

In conclusion, facet joint syndrome and herniated disc are common conditions affecting many individuals. It is caused by wear and tear or repetitive stresses and strains over time.

Conservative treatments, such as exercise and physical therapy, can help manage the pain and improve mobility. If conservative treatments fail, more invasive treatments may be necessary. It is essential to obtain a proper diagnosis from a healthcare provider to determine the most appropriate treatment plan.


Disc herniation and facet syndrome are two distinct spinal conditions that require different approaches to treatment. A thorough physical examination combined with MRI results is essential for accurate diagnosis.

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M.D. Orthopaedic Pain Management - University of São Paulo

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