How to Tell the Difference Between Facet Joint Pain and Disc Pain?

If you experience a dull ache or stiffness in your lower back, the pain often indicates facet joint pain. However, if you feel sharp, shooting pain radiating down the posterior thigh, you may have a herniated disc. You may also experience numbness, tingling, or burning pain, which can indicate nerve compression and chronic lumbopelvic pain (affecting both the lumbar and pelvic regions).

At Total Orthopedics & Sports Medicine, you can get an accurate diagnosis for your back pain. Our specialists conduct a detailed physical exam to check your facet joints and spinal nerves. We also use CT scans, MRI, and diagnostic injections to identify affected joints and nerve compression. Call us today at 855-321-6784 to book your appointment.

Which Diagnostic Tests Help Differentiate Facet Joint Pain From Disc Pain?

Physical examination (Laslett, Manchikanti, Donelson), and magnetic resonance imaging (MRI) test help differentiate facet joint pain from disc pain. Doctors may also use pain provocation tests, lumbar facet joint injections, and diagnostic injections to confirm nerve compression. Here’s how these tests help diagnose disc herniation and facet joint pain:

Physical Examination

A physical examination helps identify the affected joint and detect facet joint degeneration, as well as lower extremity issues (such as pain/numbness in the legs, thighs, or feet). Here are the main physical exams that detect spinal issues:

• Clinical Examination Laslett: Assesses sacroiliac joint pain and facet joint pain by applying pressure to the pelvis and lumbar spine. According to Physeopedia, this test has a sensitivity of 88% and a specificity of 78%.
• Manchikanti Test: Detects painful facet joints and degeneration by targeting the lumbar regions.
• Clinical Examination Donelson: Reproduces facet pain through lumbar extension and rotation to identify affected joints
• Gait Analysis: Observes walking patterns to identify nerve compression or disc herniation. It also helps identify spinal instability by detecting uneven steps or difficulty bearing weight on one side.

Magnetic Resonance Imaging (MRI)

MRI provides detailed imaging of the lumbar spine to detect facet joint degeneration, disc herniation, spinal stenosis, and bone spurs. Moreover, according to PubMed, clinical examination findings indicate that MRI has an accuracy of 94% in assessing facet joint osteoarthritis.

Lumbar Facet Joint Injections

Lumbar facet joint injections are used to diagnose and treat facet joint pain. Injecting a local anesthetic into the suspected facet joint can temporarily relieve pain, which confirms the facet joint degeneration or damage. Here are some common lumbar joint injections used to diagnose facet joint pain:

• Medial Branch Block: According to CMS.gov, two medial branch blocks are recommended for diagnosing facet joint pain. However, the second block is performed only if the first provides more than 80% pain relief.
• Intra-Articular Facet Injection: Directly injects anesthetic into the facet joint to confirm a painful joint.
• Therapeutic Facet Injection with Steroids: Combines an anesthetic and a steroid to relieve inflammation. It also identifies the pain source.

Diagnostic Injections

Targeted diagnostic injections can confirm whether the pain results from facet joints or disc herniation. They also help assess nerve compression and guide treatment decisions. The following diagnostic injections are used to identify disc degeneration and facet joint damage:

• Selective Nerve Root Block (SNRB): Injects an anesthetic near a specific spinal column to determine if a herniated disc is causing leg pain.
• Provocative Discography: Injects contrast dye into a disc to reproduce your back pain. This helps identify which disc is actually causing the symptoms.
• Facet Joint Radiofrequency Diagnostic Block: Uses temporary nerve disruption to confirm facet joint involvement before therapeutic radiofrequency ablation.

Pain Provocative Tests

Pain provocation tests are used to differentiate facet joint pain from disc herniation. For instance, applying pressure on the lumbar spine can reproduce a dull ache, indicating a facet joint syndrome. Similarly, lifting the leg straight or bending forward may trigger sharp pain in the leg, indicating a herniated disc.

Additionally, the Kemp provocation test is performed by gently leaning backward while rotating toward the painful side. If this movement reproduces posterior thigh pain or back discomfort, it confirms facet joint involvement. However, if it causes sharp, radiating leg pain, numbness, or tingling, it indicates a herniated disc or nerve root compression.

Which Movement Restrictions Typically Indicate a Disc Condition Over Facet Pain?

Facet joint pain worsens with bending backwards, standing, or twisting, while disc pain worsens with forward bending or sitting. Other movement restrictions that indicate a disc condition are sneezing, coughing, or lifting heavy objects, which can worsen radiating leg pain. You may also have difficulty walking long distances or climbing stairs due to nerve compression.

In contrast, if you have facet joint damage, you may experience the following movement restrictions:

• Difficulty rising from a chair due to stiffness in the lumbar spine.
• Pain when rolling in bed or changing sleeping positions.
• Limited side bending or lateral movements of the trunk.
• Discomfort when carrying uneven weight, such as a bag on one shoulder.

What Type of Nerve Involvement Is Most Common in Disc Conditions and Facet Joint Disorders?

In disc conditions, the radicular nerve roots are usually affected, while in facet joint disorders, the medial branch nerves are affected. For example, when a herniated or bulging disc compresses a radicular nerve root, the nerve gets irritated. This irritation can cause radiating pain, numbness, tingling, or weakness along the nerve’s pathway.

On the other hand, when a medial branch nerve is affected due to facet joint inflammation, it transmits localized pain from the joint to the spine. Moreover, this inflammation usually causes severe stiffness around the affected facet. However, it rarely produces radiating pain, numbness, or limb weakness, unlike a compressed radicular nerve.

At Total Orthopedics & Sports Medicine, we help you diagnose the underlying cause of your back or leg pain using MRI and targeted diagnostic injections. Call us today at 855-321-6784 to identify the source of your pain and explore effective treatment options.

Which Treatments Are Most Effective for Managing Facet Joint and Disc Pain?

You can manage facet joint pain with oral anti-inflammatory medications, targeted facet injections, and minimally invasive procedures. While you can treat a herniated disc with epidural steroid injections, nerve root blocks, and traction therapy. However, in severe cases, you may need spinal surgery to restore nerve function, relieve pain, and improve mobility.

Here’s how these treatments help manage facet joint and disc-related symptoms:

• NSAIDs: Reduce inflammation around the facet joint and relieve localized back pain.
• Minimally Invasive Procedures (e.g., Radiofrequency Ablation): Interrupt pain signals from the medial branch nerves.
• Epidural Steroid Injections: Reduce inflammation around the compressed nerve root to relieve radiating leg pain.
• Nerve Root Blocks: Target specific nerve roots to confirm the pain source and provide temporary pain relief.
• Spinal Surgery: Removes or repairs the herniated portion of the disc to restore nerve function.

Our spine specialists at Total Orthopedics & Sports Medicine offer advanced treatments to help alleviate nerve pain and restore function. Moreover, we closely monitor your recovery to track progress and ensure the best possible outcomes. Contact us to schedule your consultation today.

Are Manual Therapy Techniques Beneficial for Facet Joint Pain?

Yes, manual therapy can help you relieve facet joint pain. For instance, spinal decompression therapy gently stretches your spine to relieve pressure on the facet joints. This stretch can also reduce stiffness, improve mobility, and decrease localized pain. Similarly, soft tissue mobilization targets the muscles and connective tissue around the facet joints. It also helps release tension and improve blood flow, which can relieve pain and support spinal movement.

Tip: During spinal decompression therapy, maintain a slight bend in your knees to reduce strain on the lower back.

Our Spine Specialists Can Assess Whether Your Pain Is Facet- Or Disc-Related — Visit Total Orthopedics & Sports Medicine!

Ongoing pain from a herniated disc and facet joints can severely affect the quality of your life. You may experience stiffness, swelling, or weakness in your back during simple movements, such as walking or bending. In such cases, an inaccurate diagnosis can delay proper treatment, increasing the risk of further nerve damage and reduced spine function.

Our team at Total Orthopedics & Sports Medicine uses MRI, ultrasound, and diagnostic injections to assess your spinal nerves. Moreover, to speed up your recovery, our team offers all treatments under one roof, including NSAIDs, decompression, spinal surgery, and pain management. Call us today at 855-321-6784 or visit our clinic at 16 East 29th Street, Bayonne, NJ 07002, to begin your treatment.

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