A Guide to Medial Branch Blocks for Diagnosing Facet Joint Pain
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Published in The Ospina Orthopedic Blog ~ 5 min read ~ Last Updated: November 18, 2025
Pinpointing the Source of Your Back Pain
Chronic back pain is complex. You may have been told you have a "bulging disc" or "arthritis," but scans often don't tell the whole story. To effectively treat your pain, we need to know exactly where it is coming from. Is it the disc? The nerve? Or is it the small joints at the back of your spine called the facet joints?
At Ospina Medical, we believe that a precise diagnosis is the foundation of successful treatment. One of the most valuable tools Dr. Matthew Kohler uses to solve this puzzle is the Medial Branch Block.
What Is a Facet Joint?
Facet joints are the small, thumbnail-sized hinges located on the back of your spinal column. They allow you to bend and twist. Like any joint, they can become arthritic or injured. When this happens, they send pain signals to your brain via tiny nerves called "medial branch nerves."
How a Medial Branch Block Works
Think of a Medial Branch Block as a diagnostic test rather than a permanent cure.
- The Procedure: Using live X-ray guidance (fluoroscopy), Dr. Kohler places a small amount of anesthetic (numbing medicine) near the medial branch nerves connected to the suspected painful joints.
- The Test: Immediately after the injection, we ask you to perform movements that usually cause you pain (like leaning backward).
- The Result: If your pain is significantly reduced (typically by at least 50%) for the duration of the anesthetic, we have confirmed that the facet joints are the source of your pain.
Moving Forward: Your Treatment Options
Once we have a confirmed diagnosis, we can discuss long-term solutions. In traditional pain management, a positive block (sometimes two) often leads to Radiofrequency Ablation (RFA), a procedure that burns the nerve to stop the pain signal. While effective for pain relief, RFA destroys the nerve and can sometimes weaken the small stabilizing muscles of your back (multifidus atrophy), leading to potential long-term instability.
At Ospina Medical, we offer advanced regenerative alternatives for qualifying patients. Instead of creating a lesion in the problem nerve, we may recommend injecting Platelet Lysate or PRP by Regenexx into the joint and around the nerve. This aims to:
- Reduce neurogenic inflammation and calm the nerve naturally.
- Improve the health of the joint environment.
- Preserve the function of your stabilizing muscles, keeping your spine strong.
Clarity Leads to Relief
You don't have to guess about your back pain. A Medial Branch Block provides the clear answers needed to build a personalized treatment plan. Schedule a consultation with Dr. Matthew Kohler to take the guesswork out of your recovery and explore your options for lasting relief.
A Riley Publication ~ Branded Thought Leadership by Riley Partners and Publications, Inc.
Medically Reviewed by: Matthew Kohler, MD
References
Cohen, S. P., & Raja, S. N. (2007). Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology, 106(3), 591-614.
Manchikanti, L., et al. (2016). Diagnostic utility of facet joint injections in chronic spinal pain: Systematic review of evidence. Pain Physician, 19, E455-E484.
Perolat, R., et al. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights into Imaging, 9(5), 773-789.
Wu, P. B., et al. (2016). Postoperative multifidus muscle atrophy and the outcome of lumbar disc herniation surgery. Pain Physician, 19(7), E1051.
Disclaimer
This article is for informational purposes only and does not constitute medical advice. Please consult with your healthcare provider for any personal health concerns.