Facet joints in the back/neck (spine) can cause pain from inflammation or degeneration of the joints. However, they can also be implicated in pain syndromes with otherwise completely normal imaging, as well. The facet joints both allow and limit rotation in the backbone (spine), ensuring that the bones (vertebrae) do not slip out of position. Facet joint syndrome can lead to lower back pain(lumbar spine), buttocks, and thighs. Suggestive features with history include pain largely isolated to the affected segment of the spine, with distal symptoms below the knee quite rare. No localizing neurologic symptoms are generally seen. The gold standard for diagnosis is image guided facet injection, in which medication is injected in close proximity to the nerves that carry the signal from these joints, or into the joints themselves. This can often be sufficient to decrease the pain to manageable levels in combination with medications, physical therapy or home exercise. If duration is limited, radiofrequency treatment can be considered in which needles with a special probe tip are used that can interrupt the signal from the joint. Duration of symptom improvement under these circumstances can last up to a year or longer. The facet joints are frequently implicated in ‘whiplash’ type injuries following motor vehicle collisions.