Etiology — what causes it

Pain originating from the synovial zygapophyseal (facet) joints. Drivers include age-related degenerative arthrosis, capsular irritation from extension and rotation loading, repetitive end-range loading, and post-traumatic capsular injury. The facet joints have a rich innervation from the medial branches of the dorsal rami, supporting their role as a pain source.

Epidemiology — who gets it

Estimates of facet joint contribution to chronic low back pain range from 15–45% depending on the population and diagnostic criteria used. Prevalence increases with age — common in adults over 50. Often coexists with other low back pain generators.

Clinical signs

Localized paraspinal tenderness over the involved level, pain reproduction with extension and ipsilateral rotation (Kemp's test / quadrant test — modest diagnostic value clinically), pain reproduction with segmental PA pressure, no neurological deficit, no neural tension findings.

Symptoms

Localized, often unilateral low back pain that may refer into the buttock or upper posterior thigh (rarely below the knee). Aggravated by extension, standing, walking downhill, and rotation. Eased by flexion and sitting forward.

Best evidence for chiropractic treatment

Manual therapy combined with exercise produces small-to-moderate improvements (Bronfort et al., Spine Journal systematic reviews). Motor control retraining of the deep stabilizers and addressing extension-biased movement patterns is supported by clinical reasoning frameworks. Radiofrequency neurotomy of medial branches has evidence for selected cases with positive diagnostic blocks but is reserved as a later option (Manchikanti et al., Pain Physician). Active care including hip mobility, glute activation, and graded loading is foundational.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Facet-mediated low back pain often improves with manual therapy, addressing extension-biased habits, and progressive hip and core control work.