What Are Facet Joint Injections, and Do They Work?
A facet joint injection puts a small amount of local anaesthetic, sometimes mixed with steroid, straight into one of the small joints at the back of the spine. It has two uses. It helps confirm whether a facet joint is causing your pain. In some cases, it also gives temporary relief. Injections do not fix the underlying problem, and results vary from person to person.
Key points
- Facet joint injections have two roles: diagnosis and short-term pain relief.
- A medial branch block targets the tiny nerves that supply the joint, not the joint itself.
- If a diagnostic block works, radiofrequency denervation may give longer-lasting relief.
- Choosing the right patients matters. Standing, weight-bearing imaging can show facet problems that lying-down scans miss.
- Injections are not a cure. They work best as part of a wider plan that includes physiotherapy.
What is a facet joint injection?
A facet joint injection is a procedure guided by imaging. A needle is placed into or next to one of the facet joints in your spine. These small joints come in pairs and sit at the back of each vertebra. They let your spine bend and twist. When they become irritated or worn, a condition called facet joint arthropathy, they can cause localised back or neck pain. This pain is often worse when you lean backwards, twist, or stand for a long time.
The injection usually contains local anaesthetic. Sometimes it also contains a corticosteroid to reduce inflammation. It is done as a day-case procedure under X-ray or CT guidance, so the clinician can see exactly where the needle is going.
What are the different types of facet joint procedure?
There are three main approaches. Each has a slightly different purpose. The right one for you depends on the goal: diagnosis, short-term relief, or longer-lasting pain management.
Local anaesthetic is injected into the joint. If your pain goes away for a few hours, the facet joint is very likely the source. This is often the first step before any further treatment.
Instead of injecting the joint itself, the anaesthetic targets the medial branch nerves. These carry pain signals from the facet joint. This is a more precise diagnostic test. It is often required before radiofrequency treatment is approved.
This is also called radiofrequency ablation. A heated needle tip is used to disrupt the medial branch nerve, so it can no longer send pain signals. Relief usually lasts longer than with injections alone, often several months to over a year, though the nerve can grow back.
How long do facet joint injections last?
A diagnostic injection with anaesthetic alone may relieve pain for only a few hours. That short window is the point. It tells the clinician whether the facet joint is the true source of your symptoms.
When steroid is added, some people have weeks or even a few months of less pain and inflammation. Others find little lasting benefit. The evidence on steroid injections for facet joints is mixed, and repeat procedures are common.
Radiofrequency denervation tends to last longer. Published studies suggest many patients get meaningful relief for six to twelve months or more. When the nerve grows back and the pain returns, the procedure can usually be repeated.
Why choosing the right patients matters
Facet joint injections work best when the clinician is confident the facet joint is truly causing the pain. That confidence comes from two things: a thorough clinical assessment and the right imaging. If the wrong joint is targeted, or the real problem lies elsewhere, an injection will not help, however well it is done.
This is why the quality of your imaging is so important. Wear and tear at several levels of the spine is common, especially with spondylosis. Standard lying-down scans may not show which joints are under the most mechanical stress. Lying down removes the load that brings on your symptoms.
Why does standing imaging matter before a facet joint injection?
Standing, weight-bearing imaging shows your spine the way it actually works: upright, under load, and affected by gravity. Facet joints carry load. When you lie down for a normal X-ray, CT or MRI, gravity is removed and your muscles relax. The spine settles into a position it never holds in daily life. Shifts in alignment that stress certain facet joints may simply disappear on a lying-down scan.
Your body is a connected chain from your feet to your head. A slight pelvic tilt or a difference in leg length can load one side of the spine more than the other. This overworks certain facet joints. ScanAlign, weight-bearing standing imaging captures the whole skeleton in one upright scan, using about 90% less radiation than a standard X-ray, around ten times less. That full-body view helps find the mechanical cause of facet overload, not just the joint that hurts.
If you are thinking about facet joint injections and want to understand the alignment behind your pain, a standing spine scan can give vital context before you commit to a procedure.
Book a free video consultationWho is a good candidate for facet joint injections?
Good candidates are people whose pain pattern strongly suggests the facet joints are involved, and whose imaging supports that. Injections work best as part of a wider management plan, not as a fix on their own.
- Pain mainly in the back or neck that gets worse when leaning backwards or twisting
- Localised tenderness over the facet joints
- Imaging that shows facet arthropathy at a specific level
- Symptoms that have not improved with physiotherapy and simple painkillers alone
- Pain that spreads strongly down the leg (may be a disc or nerve root issue)
- Widespread pain without a clear mechanical pattern
- No imaging evidence of facet joint wear
- Expecting a permanent cure from a single injection
When MRI is the better tool. EOS and standing X-ray show bones, joints and whole-body alignment very well. But if your clinician suspects a disc bulge, nerve compression, or soft-tissue inflammation, MRI is usually the better choice for those structures. The two types of imaging work well together.
A note on urgent symptoms
If you have sudden numbness in your legs, weakness that is getting worse, or any loss of bladder or bowel control, do not wait for an injection or a scan. Contact your doctor or go to the nearest emergency department straight away. These symptoms need urgent medical attention.
What is recovery like after a facet joint injection?
Recovery from a facet joint injection is usually quick. Most people leave the clinic within an hour and can return to normal activities within a day or two. You may feel some soreness around the injection site for a short while.
After a diagnostic block, your clinician will ask you to keep a pain diary for a few hours. You note what changed and when. This helps decide whether the targeted joint is truly the source of your pain.
Physiotherapy alongside injections is often recommended. The injection can give you a window of less pain, so you can take part more fully in strengthening and mobility exercises. Without that rehabilitation work, pain is more likely to return once the injection wears off.
Before you start a treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in your pelvis, your legs or your spine changes what will actually help.
Frequently asked questions about facet joint injections
Most people describe a brief sting and a deep feeling of pressure. Local anaesthetic is used to numb the skin first. The procedure is usually over in a few minutes and is well tolerated.
A diagnostic block lasts a few hours. A steroid injection may give relief for weeks to a few months. Radiofrequency denervation often lasts several months to over a year, though results vary from person to person.
A facet injection goes into the joint capsule. A medial branch block targets the small nerves that supply the joint. Both are diagnostic, but medial branch blocks are generally considered more precise. They are usually required before radiofrequency denervation.
Yes. In the UK, facet joint injections and medial branch blocks are available through the NHS, though waiting times can vary. There, a GP or a spinal specialist can refer you.
Serious complications are rare. The main risks include temporary soreness at the injection site, infection, and a short-term increase in pain. Your clinician will discuss the specific risks with you beforehand.
You usually need a referral from your doctor or a specialist for the injection itself. However, you can refer yourself for a standing spine scan at ScanAlign to help clarify the picture before you see a specialist. You can book a standing spine scan without a referral.
Steroid injections reduce inflammation around the joint. Radiofrequency denervation uses heat to interrupt the nerve that carries pain signals. Denervation tends to give longer-lasting relief and does not rely on anti-inflammatory medicine.
Facet joints carry load. When you lie down, gravity is removed and pressure on the joints eases. Shifts in alignment and uneven loading that stress certain facet joints in daily life may not show on a lying-down MRI or CT. Standing imaging captures your spine under its normal working load.
Yes. An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. It captures your full skeleton in a single standing image with a very low dose.
The price for patients travelling from abroad is confirmed during the free video consultation. You can read more on the ScanAlign FAQs page.
Understand your alignment before your next procedure
A standing whole-body scan can show whether alignment or compensation is loading your facet joints unevenly. Talk to us for free before you commit to treatment.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- NICE Clinical Knowledge Summaries. Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59, 2016 (updated 2020).
- Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020;45(6):424-467.
- Royal College of Radiologists. iRefer: Making the best use of clinical radiology. RCR guidelines for imaging referral.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.