What is actually happening

Facet joints are the small paired joints at the back of each vertebra that let your spine extend, rotate and side-bend. Like any joint, they can develop arthritic change and a swollen, irritated capsule, and a 2022 review in the Korean Journal of Pain describes that capsular inflammation, rather than the arthritis itself, as the actual source of the ache — which is why two spines with similar arthritic wear on imaging can hurt very differently. Extension-loaded postures compress these joints directly: leaning back to see a screen mounted too high, or any job that puts the neck or low back into sustained extension, drives repetitive load into exactly the joint that is already inflamed. Pain worsens with extension and rotation and eases with flexion, the reverse of a disc problem.

Why it hides on the scan that found your disc

An MRI is good at showing arthritic change in a facet joint. It is not good at telling you whether that particular joint is the one generating your pain, because facet arthritis is common in pain-free spines and its severity on imaging correlates poorly with symptoms. So the disc or the arthritis that the report flags becomes the working diagnosis by default, treatment gets aimed there, and it does not help — not because the treatment was wrong, but because the target was never confirmed.

The only way to actually find it

Each facet joint is supplied by small sensory nerves called medial branches. Anesthetizing the medial branches feeding a suspected joint, under fluoroscopic guidance, is the only reliable way to confirm that joint as the source — if your usual pain disappears while that nerve is numb, the joint it serves is implicated. A single block is informative; because placebo response and false positives happen, a second, confirmatory block on a separate day is the standard this practice follows before recommending a permanent nerve treatment based on the result.

Whiplash and the facet joints

After a rear-end collision, the cervical facet joints are a leading source of the neck pain that follows, even when imaging looks unremarkable. A 2025 review in Pain Practice on whiplash-associated disorder describes capsular injury to these joints during the whip-like extension-flexion motion of a collision as a primary driver of chronic post-collision neck pain, distinct from and often missed alongside any disc or ligament injury the initial workup focused on. That is the exact population this practice sees along the airport corridor after a crash on I-70: a normal-looking scan and a joint that was never tested.

RFA as the durable answer

Once medial branch blocks have confirmed a joint, radiofrequency ablation heats the same nerves to interrupt the pain signal for months at a time rather than hours. A 2024 meta-analysis of placebo-controlled trials in La Radiologia Medica confirmed real, durable benefit for confirmed lumbar facet pain specifically — not for back pain generally, which is precisely why the confirmation step is not optional. The nerve eventually regrows, so relief is not permanent, but it is the most durable answer this practice has for pain that a scan alone could never have located.

When surgery is not part of the plan

For confirmed facet-mediated pain without instability, nerve compression or a structural deformity driving it, surgery is not part of the treatment plan — medial branch blocks and radiofrequency ablation are the definitive interventional answer, and fusion is not indicated to treat facet pain in isolation. That changes only if imaging and exam together show a separate structural problem, such as spondylolisthesis with instability, which is a different diagnosis entirely and would be discussed as its own conversation.

Red flags, in plain terms

Common questions

Related reading

• Medial branch block
• Radiofrequency ablation
• Sacroiliac joint pain
• After a car accident
• Herniated disc