Lumbar Facet Joint Injections: Procedure, Recovery, Results

Facet joint pain is one of the most common causes of chronic lower back pain, and it is also one of the most treatable when correctly identified. But it is frequently missed. Facet pain is often lumped together with “lower back pain” and treated with approaches that work better for other sources. This guide explains what the facet joints are, how facet joint pain is recognized, and what a lumbar facet joint injection involves.

What the Facet Joints Are

At each level of your spine, there are two facet joints — small paired joints on the back of each vertebra. They connect each vertebra to the one above and below, and they guide and limit the movement of the spine. Like any joint, facet joints have cartilage surfaces and a joint capsule, and they can develop arthritis and inflammation.

When facet joints become arthritic or inflamed, they produce a characteristic pattern of pain that is important to recognize because the treatment differs from disc-related pain or SI joint pain.

Signs of Facet Joint Pain

Patients with lumbar facet joint pain often describe:

• Pain across the lower back, often on both sides, sometimes asymmetric
• Pain that worsens with extending the spine (arching backward)
• Pain that worsens with rotating the spine (twisting)
• Pain with prolonged standing
• Pain when transitioning from sitting to standing, particularly after sitting for a while
• Relief with forward bending and with sitting (sometimes)
• Pain that may refer into the buttock or upper thigh but rarely below the knee
• No clear nerve-related symptoms (no leg numbness, tingling, or weakness in the distribution of a specific nerve root)

This pattern contrasts with disc-related pain, which typically radiates into the leg in a specific nerve distribution, and with SI joint pain, which tends to be more one-sided and located slightly lower.

Diagnostic Facet Blocks (Medial Branch Blocks)

Facet joint pain is typically confirmed with a specific diagnostic procedure called a medial branch block. This is not the same thing as a therapeutic facet injection.

The medial branches are small nerves that carry pain signals from each facet joint. In a medial branch block, a local anesthetic is placed precisely at the medial branches that innervate the suspected facet joint(s) under image guidance. The patient is asked to track their pain over the next hours.

If the pain is significantly relieved during the period that the anesthetic would be expected to last, that is strong evidence the facet joints are the source. If the pain is not affected, the facets are probably not the source.

Medial branch blocks are often performed in a two-step diagnostic protocol — a first block on one day, and if positive, a second confirmatory block on a different day — before moving to longer-lasting treatment. This protocol reduces false positives and helps ensure that any subsequent procedure is directed at the correct source.

Therapeutic Facet Joint Injections

A therapeutic facet joint injection involves injecting corticosteroid (typically combined with a local anesthetic) into or near the facet joint. This differs from a medial branch block, which targets the nerves rather than the joint itself.

Therapeutic facet injections can provide pain relief for patients with facet joint inflammation. They are sometimes used when facet joint involvement is clear and diagnostic blocks are not needed, or as a first step before considering longer-term interventions.

Radiofrequency Ablation

For patients whose pain responds well to diagnostic medial branch blocks, radiofrequency ablation (RFA) — also called rhizotomy or neurotomy — can provide longer-lasting relief. In this procedure, the medial branch nerves are treated with a small heating element delivered through a specialized needle under image guidance. The heating disrupts the pain signal from those specific nerves.

RFA does not affect motor function because the medial branches only carry sensory signals. It does not affect strength or movement.

Relief from RFA typically lasts months, sometimes longer. The nerves eventually regenerate, and the procedure can be repeated when pain returns, often with similar results.

How the Procedure Is Performed

A typical lumbar facet injection or medial branch block involves:

Preparation. You change into a gown and are positioned face-down on an imaging table.

Local anesthetic. Small amounts of local anesthetic numb the skin at each target site.

Image guidance. The procedure is performed under fluoroscopy.

Needle placement. Your physician advances needles to the target locations — into the facet joint(s) for therapeutic injection, at the medial branches for a block. Contrast dye may be used to confirm placement.

Medication injection. The anesthetic (and corticosteroid if therapeutic) is slowly injected.

Monitoring and discharge. Brief observation, post-procedure instructions, release. You are typically asked to track your pain over the next hours so that the results of a diagnostic block can be interpreted.

For radiofrequency ablation, the procedure is similar but includes a test stimulation followed by the radiofrequency treatment itself. RFA typically takes somewhat longer than a simple injection.

What to Expect After the Procedure

Activity guidance. Most patients can walk out of the clinic and are given specific guidance for the day of the procedure and the following days.

Timing of relief. For therapeutic facet injections and diagnostic blocks, the anesthetic component may provide brief relief quickly. The steroid effect, when present, typically develops over days. For RFA, pain relief often develops over 2 to 4 weeks as the treatment takes effect; some patients experience a brief period of increased soreness in the procedure area before the benefit emerges.

Duration of relief. Therapeutic facet injections: typically weeks to months. RFA: typically months, sometimes longer.

What does not work. Expectations matter. A facet injection does not fix the underlying arthritic change. For patients who respond well, the relief provides a window for more productive physical therapy and better daily function; for those who do not respond, the plan typically moves to another approach.

The Broader Treatment Plan

Facet pain, like most chronic pain, is managed most effectively with a multi-component plan:

• Correct diagnosis via history, physical exam, and diagnostic blocks when indicated
• Targeted intervention — therapeutic injection or RFA when appropriate
• Physical therapy focused on core and back stabilization
• Posture and ergonomic adjustments where relevant
• Medication support as appropriate
• Reassessment over time

Patients who combine an effective intervention with the other pieces typically do better than patients who rely on the injection alone.

Facet Joint Care at Southwest Pain Management

Our clinics offer the full range of facet joint diagnostics and treatments — diagnostic medial branch blocks, therapeutic facet injections, and radiofrequency ablation when indicated. Our team is led by Philip Morgan, MD.

Frequently Asked Questions

How do I know if my back pain is from the facet joints? Pattern of pain and physical examination offer clues. Medial branch blocks are the most reliable way to confirm facet joints as the pain source.

Is a facet injection safe? Considered generally safe when performed by a trained specialist with image guidance. Like any procedure, it carries some risks, which your physician will review.

How long does relief last? For therapeutic facet injections, typically weeks to months. For radiofrequency ablation, typically months, sometimes longer.

Can radiofrequency ablation be repeated? Yes. The treated nerves eventually regenerate, and the procedure can be repeated when pain returns.

Will RFA affect my strength or movement? The medial branches carry sensory signals, not motor signals. RFA does not affect strength or muscle function.

Do I need an MRI before a facet procedure? MRI can be useful but is not always required. Your physician will discuss whether imaging is needed in your case.

What if the diagnostic block does not relieve my pain? That is useful information — it suggests the facets are not the main pain source, and the plan shifts to investigating other possibilities.

Request a Consultation

Contact Southwest Pain Management to discuss whether facet joint evaluation and treatment is the right next step.