I've been having low back pain off and on for the last two months. It's worse after sitting for more than an hour. The doctor and physiotherapist both tell me it's from worn out facet joints. How can they tell this without an MRI?

Despite our advances in technology, there are some things that can’t be easily seen. Some conditions are still diagnosed based on the patient’s history, signs and symptoms, and tests performed by the doctor or therapist. Facet joint syndrome is one of those problems.

The facet joints allow movement in the spine. This includes bending forward, backward, and sideways. Twisting, rotating, and turning also occur at the facet joint. Like all joints, this one has a lining and fluid that can wear thin and dries out with aging.

Pain from a facet joint problem is usually dull and deep. The patient has trouble pointing to just one area of pain. Sitting or standing too long makes it worse. Combining two movements, such as twisting and bending bring on the pain. Slouch sitting seems to make it better … at least for a short time.

The only way to know for sure is to inject the joint with a local anesthetic. Complete relief of pain with local injection confirms the diagnosis.

Christian B. Bärlocher, MD, et al. Kryorhizotomy: An Alternative Technique for Lumbar Medial Branch Rhizotomy in Lumbar Facet Syndrome. In Journal of Neurosurgery: Spine. January 2003. Vol. 98. No. 1. Pp. 14-20.