Medial Branch Block
A stiff, aching spine that hurts more when you twist, lean back or stand for long periods is often a sign that the small joints in your neck or back are irritated. Whatever the location, the first step is finding where the pain actually starts. At MVM Health, our pain specialists use image-guided medial branch blocks to find out whether those joints are the source of your pain, and to give you relief while we plan your next step.
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At MVM Health — Movement. Vitality. Medicine. — we are committed to providing exceptional pain, vein, and wellness services that empower individuals to reclaim their health and well-being. With our team of Harvard-trained experts, we strive to deliver transformative outcomes that restore comfort, confidence, and quality of life. MVM Health’s mission is to help every patient relieve discomfort, restore motion, and renew life.
Vwaire Orhurhu, MD, MPH
Harvard Medical School
Mariam Salisu, MD, MPH
Harvard Medical School
Peter Isaac, DO
Philadelphia College of Osteopathic Medicine
Ali Amin, MD
Baylor College of Medicine
THOMAS KHOURY, MD
Harvard Medical School
ANTHONY TURNER, MD
Yale School of Medicine
KIRAN C. TAMIRISA
Baylor College of Medicine
TARIQ ALFARRA, DO
JOHNS HOPKINS HOSPITAL
Rishi Sheth, MD
University of Miami School of Medicine
Henry Onyeaka, MD, MPH
Harvard Medical School
Felicia Todd, CNP
Moravian College
Carrie Ward, CNP
Franklin University
Kruti Solanki, CNP
Drexel University
Christy Daniels, CNP
Chamberlain University
Heerina Kittel, CNP
Maryville University
Vic Urbano, CNP
Walden University
Jameela Azeem, CNP
Hofstra University
Vwaire Orhurhu, MD, MPH
Harvard Medical School
Mariam Salisu, MD, MPH
Harvard Medical School
Peter Isaac, DO
Philadelphia College of Osteopathic Medicine
Ali Amin, MD
Baylor College of Medicine
THOMAS KHOURY, MD
Harvard Medical School
ANTHONY TURNER, MD
Yale School of Medicine
KIRAN C. TAMIRISA
Baylor College of Medicine
Rishi Seth, MD
University of Miami School of Medicine
Henry Onyeaka, MD, MPH
Harvard Medical School
Felicia Todd, CNP
Moravian College
Vic Urbano, CNP
Walden University
Jameela Azeem, CNP
Hofstra University
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What Is a Medial Branch Block?
Your spine has small paired joints at the back of each vertebra, called facet joints. They guide and limit how your spine moves. Each facet joint is supplied by tiny nerves called medial branch nerves, which carry pain signals from the joint to your brain. When the joints are irritated by arthritis, wear or injury, those nerves can send pain signals that feel like a deep ache in the neck or back.
A medial branch block (MBB) is an injection of numbing medicine next to these nerves, guided by live X-ray. If your pain drops significantly while the medicine is working, it tells your provider that the facet joints are very likely the source of your pain.
Diagnosis first, relief second. Facet joint pain is hard to confirm from an exam or imaging alone, because it looks like many other kinds of spine pain. An MBB answers that question. It also gives short-term relief, and sometimes longer relief if a steroid is added.
The step before radiofrequency ablation. If a block gives you strong relief, your provider may recommend radiofrequency ablation, which quiets the same nerves for months. Some providers confirm the result with a second block on a different day.
Different from an epidural. An epidural injection treats an irritated nerve root that causes pain into an arm or leg. An MBB targets the nerves of the joints themselves, so it is used for neck and back pain that stays near the spine.
Image-guided for accuracy. Your provider uses live X-ray (fluoroscopy) to place a thin needle next to the nerve. The injection takes about 15 to 30 minutes, and you go home the same day. Side effects are usually mild, such as temporary soreness, and serious complications are rare. Your provider reviews your risks before the procedure.
Where Can a Medial Branch Block Be Done?
Your provider chooses the level of the spine based on where your pain starts and what your exam and imaging show.
Neck (cervical spine)
A cervical medial branch block is used for neck pain that can spread into the shoulders or upper back, and for headaches that start at the base of the skull. Learn more about neck pain.
Mid-back (thoracic spine)
Thoracic facet joint pain is less common. A block can be used for a dull ache between the shoulder blades when it is traced to the thoracic facet joints.
Lower back (lumbar spine)
The most common site. A lumbar medial branch block is used for low back pain that may spread to the buttock or upper thigh and gets worse with leaning back or twisting. Learn more about back pain.
Bottom of the spine (sacroiliac joints)
Pain at the base of the spine can come from the sacroiliac (SI) joints. A similar block, called a lateral branch block, can help find out whether those joints are the source. See sacroiliac joint injection.
Common Causes of Facet Joint Pain
Facet joint arthritis
Wear and tear can thin the cartilage in the joints, making them stiff and painful. See our page on arthritis.
Spondylosis
Age-related changes across the spine, including bone spurs and swollen joints, can irritate the facet joints. See our page on spondylosis.
Degenerative disc disease
When discs thin with age, the facet joints take on more load and can become painful. See our page on degenerative disc disease.
Car accidents and injuries
Whiplash, falls and sports injuries can strain or damage the facet joints.
Poor posture and repetitive strain
Long hours sitting, bending, lifting or twisting can overload the joints over time.
Spinal stenosis
Changes that narrow the spinal canal often involve swollen facet joints, which can add to back pain. See our page on spinal stenosis.
Spondylolisthesis
When one vertebra slips over another, the facet joints can be strained. See our page on spondylolisthesis.
Previous spine surgery
A fusion can shift more stress onto the joints above and below it.
Risk Factors
Anyone can develop facet joint pain, but it’s more likely if you:
- Are over age 40, when discs and joints naturally begin to wear
- Sit for long hours, especially with poor posture
- Lift, bend or twist often at work
- Carry extra body weight, which adds load to the spine
- Smoke, which reduces blood flow to spinal discs
- Have had a previous neck or back injury or spine surgery
- Have a family history of arthritis or disc problems
Symptoms
- A deep, aching pain in the neck or lower back, often on one side or both
- Pain that spreads to the shoulders, upper back, buttocks or upper thighs, but usually not below the knee
- Pain that gets worse when leaning back, twisting or looking up
- Stiffness in the morning or after sitting, which eases somewhat with movement
- Tender spots along the spine
- In the neck, headaches that start at the base of the skull
- Trouble standing up straight, walking or sleeping comfortably
When Pain Needs Urgent Care
Most neck and back pain isn’t an emergency. Get urgent medical care if your pain comes with:
- Loss of bladder or bowel control, or numbness in the groin or inner thighs
- Weakness in a leg or arm that is getting worse
- Fever, chills or feeling generally unwell
- A history of cancer, or unexplained weight loss
- Severe pain after a car accident, fall or other injury
- Chest pain or trouble breathing (call 911)
These signs can point to infection, a fracture, nerve compression or another condition that needs prompt attention.
Book a pain evaluation
Other Treatment Options
Spine pain management starts with the least invasive options and steps up only when needed. An epidural is one option among several, and most people with spine pain never need surgery.
Conservative care
Anti-inflammatory medicine is placed near irritated spinal nerves to ease pain that radiates into an arm or leg, such as from a herniated disc or stenosis.
Medicine is placed in or near the small joints of the spine to ease arthritis pain. A positive response also helps confirm where the pain starts.
Controlled heat quiets the small nerves that carry pain signals from arthritic spine joints. It’s often considered after a successful nerve block.
A small device sends mild electrical pulses that change how pain signals reach the brain. It’s used for long-term pain that hasn’t responded to other care, and it starts with a short trial.
Platelets from your own blood may support healing in some joint and soft-tissue conditions. Your provider will tell you whether it’s a reasonable option for you.
Getting the Most From Your Medial Branch Block
The hours after a block tell your provider a lot about where your pain comes from. These steps can help you get a clear answer:
If your pain returns quickly, or you notice fever, new weakness, or redness or drainage at the injection site, call our office.
Test your usual movements. While the numbing medicine works, gently do the movements that normally hurt, within your provider’s guidance, and note how they feel.
Keep a pain diary. Write down your pain level before the block and at regular times afterward, and note how long the relief lasts. Your provider uses this to decide the next step.
Take it easy at first. You may feel temporary numbness or heaviness. Rest for the first day, then ease back into normal activity as your provider advises.
Use ice for soreness. Ice at the injection site can calm soreness for the first day or two.
Stay gently active. Short walks, gentle stretching and good posture usually help more than bed rest, and physical therapy can help relief last longer.
Keep a healthy weight. Less weight means less load on your spine. For some patients, a provider-guided medical weight loss program becomes part of their plan.
Frequently Asked Questions
It is an image-guided injection of numbing medicine next to the medial branch nerves that carry pain signals from the facet joints. It is used to find out whether those joints are causing your neck or back pain, and it can give short-term relief.
Both. Its main purpose is diagnostic, since strong relief points to the facet joints as the source. It also provides temporary relief, and a good result can lead to longer-lasting treatment such as radiofrequency ablation.
Most patients feel brief pressure or a pinch. The skin is numbed first, and imaging guidance keeps the procedure precise. Some soreness afterward is common.
The injection itself usually takes about 15 to 30 minutes. Plan on roughly an hour at the office including check-in and a short rest.
It depends on the medicine used. Numbing medicine alone may relieve pain for several hours, while some patients get longer relief if a steroid is included. Even short relief gives your provider useful information.
Some providers perform a second confirmatory block on a different day to be sure the facet joints are the true source before recommending radiofrequency ablation.
If your pain improves significantly, it suggests the facet joints are the cause. Your provider may then discuss radiofrequency ablation for longer relief, along with physical therapy.
That is useful too. It points your provider toward other causes of pain, such as discs, nerve roots or the sacroiliac joint, so the plan can change.
Medial branch blocks are widely used and generally safe when done by experienced physicians with imaging guidance. Possible side effects include temporary soreness or bruising and short-lived numbness. If a steroid is used, a temporary rise in blood sugar is possible. Serious complications such as infection, bleeding or nerve injury are rare. Your provider reviews your risks before the procedure.
Many patients can drive, but if you receive sedation or feel numb or weak, you will need a ride home. Light walking is encouraged, and doing your usual movements helps test your relief. Heavy lifting and intense workouts may need to wait a day or two.
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