Pain that worsens when standing: warning signs of facet syndrome
Many people live with chronic lower back pain without knowing exactly what causes it. One of the most common patterns seen in clinical practice is pain that worsens when standing for long periods, walking, or arching the back backward.
In some cases, this type of pain may be related to lumbar facet syndrome, a common cause of back pain associated with wear and tear of the facet joints in the spine.
Although it is often mistaken for muscle or disc problems, correctly identifying its symptoms is essential for determining the appropriate treatment.
What is facet syndrome?
Facet syndrome is a type of lower back pain that originates in the facet joints, which are small joints located on the back of the vertebrae.
These joints allow:
- Stabilize the spine.
- Guide the movements.
- Promote lumbar mobility.
Over time, excessive strain, aging, or certain repetitive movements can cause inflammation and wear and tear in these structures.
What does facet joint pain feel like?
Facet pain usually has very specific characteristics.
Many patients describe:
- Deep lower back pain.
- Stiffness in the lower back.
- Pain when standing.
- Discomfort when walking for a long time.
- The pain worsens when arching the back backward.
- A sensation of stiffness in the lower back.
Unlike classic sciatica, facet joint pain does not usually extend below the knee.
Why does it hurt more when I’m standing?
When we are standing, the facet joints bear a greater mechanical load.
In addition, movements such as:
- Stretch your back.
- Rotate your torso.
- To walk for a long time.
- Maintaining postures for extended periods of time.
They can increase pressure on these joints and trigger pain.
That’s why many people feel relief when they sit down or lean forward slightly.
Warning Signs of Facet Syndrome
Some signs that may indicate this condition are:
- Lower back pain that worsens when standing.
- Morning stiffness in the lower back.
- Pain upon standing up after periods of rest.
- Discomfort when walking or arching the back.
- Pain localized in the lower back.
- A sensation of stiffness or tightness in the lower back.
In some patients, pain may also radiate to the buttocks or thighs.
What are the most common causes?
Facet syndrome is often associated with:
- Lumbar osteoarthritis.
- Spinal degeneration.
- Mechanical overload.
- Sedentary lifestyle.
- Postural alterations.
- Repetitive physical work.
- Previous injuries.
- Aging of the Spine.
It can also occur alongside other lower back problems, such as herniated discs or disc degeneration.
Differences Between Facet Syndrome and Sciatica
Although both can cause lower back pain, there are important differences.
| Facet Syndrome | Sciatica |
| Mechanical low back pain | Pain due to nerve irritation |
| It gets worse when standing or arching the back | Pain that radiates along the nerve |
| Frequent lower back stiffness | Tingling or electric shocks |
| Localized lower back pain | It may radiate down to the foot or leg |
| It gets better when sitting | May worsen when sitting |
An accurate diagnosis is essential for distinguishing between the two conditions.
How is it diagnosed?
The diagnosis of facet syndrome is based on:
- Medical history.
- Physical examination.
- Imaging tests.
The most commonly used tests include:
- X-rays.
- Magnetic resonance imaging.
- CT scan.
In some cases, diagnostic facet joint blocks may also be performed to confirm the source of the pain.
Treatment of Facet Syndrome
Treatment will depend on the severity of the pain and the extent of joint involvement.
Conservative Treatments
In the early stages, the following may be recommended:
- Therapeutic exercise.
- Physiotherapy.
- Lower Back and Core Strengthening.
- Postural hygiene.
- Load control.
- Drug therapy.
Adapted physical activity is often key to improving spinal stability and mobility.
Interventional treatments
When pain persists or significantly limits quality of life, advanced techniques such as the following may be considered:
- Facet joint blocks.
- Ultrasound-guided injections.
- Facet radiofrequency ablation.
- Interventional techniques for pain management.
Facet radiofrequency ablation is a minimally invasive technique designed to reduce pain transmission from the affected joints.
When to consult a Pain Unit?
It is advisable to seek a specialized evaluation when:
- Lower back pain persists for weeks or months.
- The pain gets worse when standing.
- There is functional limitation.
- The pain often returns.
- The usual treatments do not work.
A proper diagnosis makes it possible to determine whether the source of the pain is facet-related, disc-related, muscular, or a combination of different factors.
A Comprehensive Approach to Low Back Pain
We now know that chronic low back pain is rarely caused by a single structure. In many patients, muscles, discs, facet joints, and biomechanical abnormalities are all involved at the same time.
Therefore, treatment should be aimed not only at relieving pain, but also at restoring mobility, stability, and quality of life.
At MIVI Salud, we have specialists in pain management and advanced techniques designed to provide a comprehensive approach to treating lower back pain and facet syndrome.
Coordinator for MIVI Toledo and MIVI Madrid: Arturo Soria