How is an orthopedic test for facet dysfunction typically performed?

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The key idea is that facet joint pain is produced when the joints are loaded and stressed, then localized by feeling the joint lines. Extending the spine compresses the facet joints, and adding rotation increases that load, which often makes the facet-related pain worse. Palpating the paraspinal facet joints while performing this movement helps pinpoint the source to the z-joints rather than to muscles or other structures. That combination—provoking pain with simultaneous extension, rotation, and targeted palpation of the facet joints—best identifies facet dysfunction.

Other maneuvers don’t target the facet joints as specifically. Flexion with distraction tends to unload the facets, potentially reducing facet pain rather than provoking it. Lateral flexion alone is less reliable for localizing facet involvement, and general spinal compression is nonspecific, loading multiple structures and not distinguishing facet pain.