Medial branch block
Your health expert: Mr Purnajyoti Banerjee, Consultant Surgeon
A medial branch block is a test to see if neck and back pain come from facet joints. Your facet joints are small pairs of joints that link together the bones in your spine. If the injections help to relieve your pain, it shows that your facet joints are causing it. You may then be able to have a longer-term treatment called radiofrequency denervation.
What are medial branch block injections?
A medial branch block is an injection into your back, very close to spinal joints called facet joints. These are small pairs of joints that link together the bones in your spine.
Each facet joint is formed where the lower joint surface of one vertebra meets the upper joint surface of the vertebra below.
Facet-related neck pain is usually felt centrally or to one side of the neck and may spread towards the back of the head, shoulder, or shoulder blade. It may become worse with prolonged neck positions, looking upwards, or turning the head. However, these symptoms are not specific.
A medial branch block is primarily a diagnostic or prognostic test, rather than a treatment intended to provide permanent pain relief. A small quantity of local anaesthetic, with or without steroid, is placed beside the medial branch nerves supplying the joint suspected of causing the patient's pain. If the patient's usual pain is substantially reduced while the local anaesthetic is working, this provides evidence that one or more facet joints supplied by those nerves may be causing the pain.
How to manage your back pain at home
How to manage back pain at home | Watch in 4:06 minutes
In this video, a musculoskeletal physiotherapist explains the common causes of lower back pain and provides practical advice on how to manage it at home through movement, relaxation, and pain relief.
Back pain is one of the most common reasons people come to see a doctor or a physiotherapist. But what actually causes it, what can you do to make yourself feel better, and when should you seek help? I’m Sabrina Danzig, a musculoskeletal physiotherapist working at Bupa.
When people say they have back pain, they can be referring to different areas of the spine. There's the neck, also known as the cervical spine. Further down, we have the midback, which we call the thoracic spine. But in most cases, we’ll be talking about the lower back—the lumbar spine. This is by far the most common type of back pain that we see in the UK.
But there’s some good news: most people with back pain get better within 12 weeks of using some simple care at home. In fact, how you respond to the back pain in its early stages can make a difference between whether it gets better or whether it sticks around. In this series of Bupa Explains, we’ll give you some practical tips to help you manage your back pain effectively so that it gets better and not worse. We’ll also help you spot when you should see a doctor.
Back pain can sometimes be triggered by an injury or, more rarely, a worrying underlying condition like some cancers. But in the vast majority of cases, there’ll be something mechanical causing it, usually a type of movement. That could be poor posture, not lifting things correctly, not being active enough, or being overweight—carrying extra weight can put pressure on your spine, which can lead to pain.
Muscle imbalances, such as weak glutes or core muscles, can also cause back pain. These muscles hold your spine in place to keep it nice and strong. Poor sleep can also exacerbate your back pain, as sleep is needed to help repair and promote healing. Stress or low mood can also heighten pain in your spine.
To help yourself, there are three things that you need to do. The first is to move.
Most people’s reaction to back pain is to sit still and do nothing. They worry movement will actually worsen their back problems. But avoiding activity increases tension and stiffness, which can actually make your back pain worse.
Moving more doesn’t have to mean going to the gym. You can just try some gentle stretches, mobility exercises and walking. If you’re having severe back spasms, this might just mean a few simple exercises and walking up to 100 yards up the road—whatever you can manage daily.
Pacing is key, so start small and build up. The main thing is to try and stay as mobile as possible.
Number two: make sure you relax. Remember what we said about stress and back pain? By managing your stress, you’re taking a positive step towards managing your pain. Try breathing exercises to calm down your nervous system and reduce tension in your muscles. Yoga and meditation can all be helpful.
Lastly, if you need to take it, take pain relief. That can be paracetamol or ibuprofen. It will help you with staying active and mobile without pain. Take it as directed.
If your back pain persists for more than a few weeks or is accompanied by sudden weight loss, fever or night sweats, make sure that you seek help from your doctor.
Some symptoms need immediate attention, though, if they accompany your back pain. We call these “red flag” symptoms. These include sudden difficulty walking, shooting pains in both of your legs, numbness around your genitals or your back passage, struggling to pee or poo, or actually having complete loss of your bladder and bowel function.
If you have any of these signs, go straight to A&E. They may be signs of cauda equina syndrome, a very rare but serious condition that can lead to permanent nerve damage.
But rest assured, most back pain does go away on its own, especially if you continue with activity, managing your stress, and living a healthy lifestyle. Check out our other videos in this series to find out how. Thanks for watching. You’re now one step ahead of managing your back pain.
Why might you have a medial branch block?
If you have neck or back pain, your doctor is likely to suggest trying painkillers, exercise and sometimes physiotherapy.
But if these don’t help and your doctor thinks your pain might be linked to your facet joints, they may offer you a medial branch block. The most common cause of facet joint pain is osteoarthritis, which can cause your facet joints to become worn down and inflamed.
A medial branch block injection helps to prove to your doctor where your pain is coming from. If the injection gives you some pain relief, then the pain must be coming from that facet joint. How long the pain relief lasts varies from person to person. For some it’s only a few hours or days. But for others, the pain relief can last for a few weeks.
If a medial branch block does help you, your doctor may suggest a longer lasting treatment called radiofrequency denervation. This uses radiofrequency waves to deactivate nerves around the facet joints that are causing the pain in your back or neck. The treatment may help to relieve pain for between six months and two years – it varies from person to person.
Not everyone can have radiofrequency denervation. It’s not suitable if you have a pacemaker or implantable cardioverter defibrillator. Your doctor may suggest you have a facet joint injection instead.
A facet joint injection is similar to a medial branch block as it contains a local anaesthetic, but it also contains a small amount of a steroid. You have the injection directly into your facet joint. The aim is to reduce inflammation in your joint space. It can help to relieve pain for a while, anything from a few weeks to a few months and, sometimes, years. You may need to have repeated facet joint injections, alongside other treatment such as an exercise programme.
A medial branch block may therefore be considered when:
- you have persistent, localised neck or lower back pain
- you have pain coming from from the facet joints
- pain management and exercise-based rehabilitation has not improved your pain
- the pain has no other explanation, such as fracture or infection
How do you prepare for medial branch block?
You'll need to go into hospital to have a medial branch block. You can have the injection and go home the same day. This procedure can be performed under local anaesthesia or mild sedation and this depends on your doctor and your medical condition.
Your hospital might ask you to fast before you go for the procedure. This means you shouldn’t eat anything for a certain amount of time beforehand. Your hospital will let you know in advance if you need to do this, and for how long.
Ask a friend or family member to take you to your appointment and drive you home. Ideally, you should also arrange for someone stay with you for the first night after your procedure.
Your surgeon will discuss with you what will happen before, during and after your procedure. If you’re unsure about anything, don’t be afraid to ask. It’s important that you feel fully informed and happy to give your consent for the procedure to go ahead. When you do, the doctor will ask you to sign a consent form.
What happens during a medial branch block?
A pain specialist doctor will give you a medial branch block. You’ll need to lie on your front if you’re having the injection into your lower back; you'll lie on your side if the injection is into your neck. They may offer you sedation to help you relax. Once you’re ready, they will clean your skin and inject a local anaesthetic to numb any pain while you're having the procedure. The local anaesthetic may sting but this won’t last long.
Your pain specialist will use X-ray images to help them find the right spot on your back or neck.
When the needle is in place, the doctor gives the injection. This delivers local anaesthetic around the nerves in your facet joint.
It only takes a few minutes to give you the injection. The whole procedure should take around 20 minutes to around 40 minutes, including having the X-rays taken.
Aftercare for medial branch block
After the procedure, you'll go to a recovery room. Health professionals will monitor you there for a short time, before you leave. At first, they may ask you to lie flat. They’ll check your blood pressure or pulse and ask how you feel.
You can usually go home a few hours after the procedure. You'll need somebody to drive you home – you won't be able to drive yourself. Ideally, you should also have someone stay with you for the first night after your procedure, especially if you’ve had sedation.
Your doctor may ask you to keep a diary of your pain symptoms for a few days after you go home. This helps to show how much the injections have helped and whether further treatment will help.
You can continue to do all your normal activities when you get home, but avoid anything too strenuous for the first couple of days. As your pain improves, you should gradually increase the amount of exercise you do. It’s important not to overdo it, but exercise will improve your muscle tone and help to make your back stronger. Ask your doctor if you’re unsure about anything. For more detail, see our section on questions to ask your doctor.
What are the side-effects of medial branch block?
After a medial branch block, you may have some tenderness or bruising where you had the injection. This usually gets better within a few days. You may also have some dizziness. Occasionally, your usual neck or back pain can temporarily become worse for several days.
Some patients may experience
- temporary imbalance following cervical blocks
- light-headedness, sweating, nausea or fainting
- temporary numbness, tingling or weakness
Contact your doctor if you experience any severe side effects or are concerned.
What are the complications of medial branch block
Possible complications of a medial branch block include:
- infection
- bleeding
- injury to a nerve
- an allergic reaction to the local anaesthetic or contrast media
- develop a headache
- have any increased or unusual pain in the area where you had the injection
- have any signs of infection around the injection site – for example, redness, heat or swelling
After you’ve gone home, contact the unit where you had the procedure if you:
Considerations for medial branch block
It’s important to discuss the procedure with your pain specialist. You need to be able to make an informed decision about whether to go ahead with a medial branch block. There are some things to consider before deciding if this is the right treatment for you.
A medial branch block can help your doctor to find the cause of your neck or back pain. This means they may be able to offer you certain treatments that are more likely to help you.
If your usual pain improves substantially while the local anaesthetic is working, this gives evidence that the facet joint or joints supplied by those nerves are causing your pain.
Your physician may consider this test if your pain has been present for a significant period of time, is mainly centred in your neck or back, and has not improved sufficiently despite appropriate treatments such as exercise, physiotherapy, activity modification and simple pain management. Before performing the block, your doctor would also make sure that there is not a more important explanation for your symptoms, such as a fracture, infection, tumour, instability or significant nerve compression.15
One of the main reasons doctors perform a medial branch block is to decide whether you might benefit from a further treatment called radiofrequency denervation, which aims to interrupt the pain signals travelling through the medial branch nerves for a longer period.
If these treatments reduce the pain in your neck or back, it can make it easier to move around and improve your quality of life. You may find it easier to do physiotherapy or take part in an exercise programme. This may help to improve your condition in the long term.
It is important to understand that there is no guarantee that these injections will definitely improve your pain.
Any pain relief you get from a medial branch block will be temporary. There’s also a very small risk that you’ll have some problems during or after the operation. For more information, see our sections on side-effects and complications.
Questions to ask your doctor
Have a think about any questions you would like to ask your doctor before you decide whether to have a medial branch block or not. Here are some example questions you might like to ask.
- What can I expect to happen after I’ve had a medial branch block?
- Will I be able to exercise after the injection? Are there any types of exercise it's best not to do?
- How can I tell if my injection has worked to show that my neck and back pain comes from my facet joints? How long will it take until I know if it's worked?
- What is the likelihood of the procedure working?
- How will you reduce the risk of complications?
- What treatment options do I have to relieve my pain?
- Should I have physiotherapy or some other rehabilitation after having my injection?
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Our evidence-based physiotherapy services are designed to address a wide range of musculoskeletal conditions, promote recovery, and enhance overall quality of life. Our physiotherapists are specialised in treating orthopaedic, rheumatological, musculoskeletal conditions and sports-related injury by using tools including education and advice, pain management strategies, exercise therapy and manual therapy techniques.
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The main reason for having this done is to diagnose where pain is coming from rather than to treat it. But when medial branch block relieves pain, how long this lasts varies. It could be anything from a few hours to a few weeks.
No, they are different injections. A medial branch block numbs the small nerves from the spine's facet joints. This can be used to diagnose the source of back pain. A cortisone injection targets the joint itself with a steroid to reduce inflammation.
Yes, it’s encouraged to walk after a medial branch block? After a 20-to-30-minute monitoring period at your clinic, getting up to walk is important to prevent stiffness. Avoid strenuous activities, heavy lifting, or prolonged sitting for the first 24 to 48 hours.
Medial branch block isn’t usually painful. You’ll have local anaesthetic into the skin of your back and this can sting a bit. You may feel some pressure as the injection goes in. Some people have a sedative, which will make you drowsy during the procedure.
For more information, see our section on what happens during a medial branch block.
No, they are different injections. A medial branch block numbs the small nerves from the spine's facet joints. This can be used to diagnose the source of back pain. A cortisone injection targets the joint itself with a steroid to reduce inflammation.
Radiofrequency denervation
Radiofrequency denervation is a treatment for neck or back pain that comes from your facet joints. You might be offered this treatment if your pain is caused by arthritis.
Lower back pain
Lower back pain is very common. It is often caused by straining muscles, tendons or ligaments in your back. Find out everything you need to know about lower back pain.
Back surgery
Back surgery is recommended as a treatment for back pain in certain circumstances. Find out more about the types of surgery for back pain including complications and recovery afterwards.
Epidural injections for lower back, leg pain
Sometimes spinal injections (epidural or nerve root injections) are used to treat chronic back and leg pain.
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- Koura MA. & Attwa IS. Comparative Outcomes of Intra-articular Corticosteroid Injections and Medial Branch Blocks for Lumbar Facet Joint Syndrome: A Retrospective Study. Cureus. 2025 Jul 19;17(7):e88320. doi: 10.7759/cureus.88320
- Hurley RW, Adams MCB, Barad M, et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Regional Anesthesia and Pain Medicine. 2022;47(1):3–59. doi:10.1136/rapm-2021-103031
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