Low back pain and facet joint arthritis

Low back pain is very common, and most episodes improve with time and simple care. Frequent sources include strained muscles and ligaments, wear-related disc changes, and arthritis of the facet joints, the small paired joints at the back of each spinal level that guide bending and twisting. Often more than one factor contributes, and no single cause is found.

• Aching or stiffness in the low back, sometimes spreading to the buttocks or upper thighs
• Pain that is worse with arching backward, twisting, or standing for long periods, which is common with facet arthritis
• Stiffness that is worst in the morning or after rest and loosens with movement
• Muscle spasm and tenderness alongside the spine
• Pain that worsens with prolonged sitting or bending, which is common with disc-related pain

Pain that travels below the knee, especially with numbness or tingling, suggests a pinched nerve (sciatica) rather than joint or muscle pain.

Sudden back pain often follows a lift, a twist, or an awkward movement that strains muscles and ligaments. Longer-lasting or recurring pain is more often tied to age-related changes: worn discs, facet joint arthritis with thinning cartilage and bone spurs, and in some people spinal stenosis. Inflammatory conditions such as ankylosing spondylitis are a less common cause.

Factors that raise the chance of back pain include:

• Age, especially after the mid-40s
• Low fitness and weak core muscles
• Excess body weight
• Jobs that involve heavy lifting, or long periods of sitting with poor posture
• Smoking
• Poor sleep, stress, depression, or anxiety

Most back pain is diagnosed with a history and physical examination. Your clinician will also ask about warning signs that could point to a more serious cause.

Imaging is usually not needed in the first several weeks unless warning signs are present, because many findings on scans are common in people without pain. X-rays, an MRI, or a CT scan may be ordered when pain persists, when there are nerve symptoms, or when an injection or surgery is being considered. In some cases, a diagnostic injection that numbs a facet joint or its small nerves is used to see whether that joint is the source of pain.

Most back pain is treated without surgery:

• Stay as active as comfort allows; bed rest is not recommended
• Heat or ice, and over-the-counter pain relievers or other medications when appropriate
• Physical therapy and a home exercise program for core strength, flexibility, and posture
• Low-impact activity such as walking, swimming, or cycling
• Approaches such as spinal manipulation, acupuncture, massage, or yoga, which help some people
• Pain-coping strategies, including cognitive behavioral therapy for long-lasting pain

For persistent pain thought to come from the facet joints, an image-guided injection into the joint or near the small nerves that supply it may be offered. When those nerve blocks bring relief, radiofrequency ablation, which uses heat to interrupt the nerves' pain signals, may be considered; the nerves can regrow, so relief may not be permanent.

Surgery is rarely needed for back pain without nerve compression, instability, or deformity, and is considered only after a thorough course of non-surgical care.

Many episodes of new back pain improve within days to weeks. A gradual return to normal activities, rather than waiting until pain is completely gone, is generally encouraged. Back pain often comes back, so continuing an exercise routine after symptoms settle is part of long-term care.

• Exercise regularly, including core strengthening and balance training such as yoga or tai chi
• Warm up before physical activity
• Maintain a healthy weight, and get enough calcium and vitamin D
• Lift with your legs, keep loads close, and avoid twisting while lifting
• Change positions often during long periods of sitting
• Don't smoke