Which movement directions typically increase pain in facet joint syndrome?

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Facet joints are loaded most when the spine is extended and rotated, because these motions compress and shear the posterior elements and stretch the joint capsule. Extension brings the articular processes closer together, increasing contact and capsule tension, which irritates the joint tissues and any arthritic changes. Rotation produces asymmetric loading, stressing the capsule on the rotating side and adding thrust on the joint surfaces, which often heightens pain. Flexion tends to open the facet joints and unload them, frequently reducing pain, while abduction can irritate some facet joints but is less consistently provocative than extension with rotation.