By Matthias Wiederholz, MD
Quadruple Board-Certified in Physical Medicine & Rehabilitation, Sports Medicine, Pain Medicine, and Anti-Aging, Regenerative & Functional Medicine

Introduction

As a quadruple board-certified physician specializing in spine care in Houston, I’ve evaluated thousands of patients who arrive frustrated and confused about the source of their back pain. Many have been told conflicting things by different providers—some say it’s arthritis, others suspect a disc problem, and patients are left wondering which diagnosis is correct and why it matters. Understanding whether your pain originates from spinal discs or facet joints is essential because these two conditions create pain through completely different biological mechanisms and require different treatment approaches.

Research shows that disc degeneration involves structural tears in the disc wall that allow inflammatory molecules and nerve fibers to create persistent pain signals, while arthritis affects the small stabilizing joints between vertebrae through cartilage breakdown and bone friction. Whether you’re in West University Place or Bellaire, this article will explain the key differences in symptoms, imaging findings, and pain patterns so you can have more informed conversations with your Houston spine specialist about the true source of your discomfort.

Learn more about Discseel® Procedure options here.

Read about Dr. Matthias Wiederholz’s expertise in spine and pain care.

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Understanding the Two Main Sources of Back Pain

Your spine contains two distinct structures that commonly cause pain as they age or sustain injury. Intervertebral discs sit between your vertebrae and function as shock absorbers, containing a gel-like center surrounded by tough outer rings. Facet joints connect the back portions of adjacent vertebrae and guide spinal movement while providing stability. When I evaluate patients in my Houston practice with chronic back pain, I find that understanding which structure generates their symptoms determines the entire treatment approach.

Disc problems involve tears in the annulus fibrosus that allow inflammatory molecules to leak and nerve fibers to grow inward. Facet joint arthritis develops when cartilage breaks down, and bone surfaces begin grinding together. These two conditions create pain through completely different biological mechanisms, which explains why treatments that help arthritis may not address disc pathology and vice versa.

If you’re interested in the differences between spinal arthritis and slipped disc or want to learn more about degenerative disc disease treatment options, additional treatments are available at our practice.

How Disc Problems Cause Pain: The Biology Behind Discogenic Pain

Discogenic pain begins when the annulus fibrosus develops tears or fissures that compromise the disc’s structural integrity. These annular tears allow nerve fibers to grow into areas of the disc that normally contain no nerve endings, creating new pain pathways. The nucleus pulposus leaks through these tears and triggers an inflammatory cascade involving multiple chemical mediators.

Research demonstrates that nerve growth factor and brain-derived neurotrophic factor accumulate in damaged discs and sensitize these newly formed nerve fibers. In my practice, I often see patients whose disc pain persists because the annular tear itself never healed, allowing continuous leakage and inflammation. Inflammatory cytokines regulate these neurotrophic factors and create a self-perpetuating cycle of pain signaling. Nerve growth into damaged disc tissue is associated with disc degeneration and may contribute to discogenic pain.

This mechanism explains why some patients experience constant pain even when imaging shows relatively mild degeneration—the biological activity within the disc matters more than the degree of height loss.

Curious about disc tear treatment and restoring spinal integrity? Learn more on our blog.

How Spinal Arthritis Causes Pain: Facet Joint Degeneration

Facet joint arthritis develops through a different degenerative process that affects the small stabilizing joints between vertebrae. These joints contain cartilage that normally allows smooth gliding motion during bending and twisting movements. As cartilage breaks down over time, bone surfaces lose their protective cushioning and begin making direct contact. This bone-on-bone friction triggers inflammation in the joint capsule and surrounding tissues.

Pro-inflammatory cytokines drive pain signaling in these degenerating joints through mechanisms similar to arthritis in other body regions. The synovial membrane lining these joints becomes inflamed and produces excess fluid, causing joint swelling and stiffness. Unlike disc pain that involves leakage and nerve ingrowth, facet arthritis creates pain through mechanical irritation and inflammatory joint changes.

When I examine patients with facet arthritis, they typically show tenderness directly over the affected joints and pain that worsens with specific movements that load these structures.

better understand managing lumbar degenerative disc disease, check out our in-depth resource.

Key Symptom Differences: Disc Pain vs Arthritis Pain in Houston

Disc pain and arthritis pain create distinct patterns that help identify the underlying source. Disc-related pain typically worsens with sitting, forward bending, lifting, or twisting because these activities increase pressure within the disc and stress the annulus fibrosus. Annular tears are associated with disc degeneration and often produce pain that radiates into the buttocks or legs in dermatomal patterns when nerve roots become irritated.

Patients with discogenic pain frequently report that their symptoms improve when standing or walking because these positions reduce disc pressure. Facet arthritis pain follows a different pattern, worsening with backward bending, twisting, or prolonged standing that compresses the facet joints. This type of pain often improves with sitting or forward bending that opens the facet joints and reduces mechanical stress.

Morning stiffness that improves with movement suggests arthritis, while pain that increases throughout the day with activity points toward disc pathology. In my practice, I use these symptom patterns as initial clues, but accurate diagnosis requires correlation with imaging findings and physical examination.

For more specifics about symptoms of a bulging disc in the neck (C5-C6) or related cervical issues, explore our blogs.

What Imaging Can Tell You: MRI and X-Ray Findings in Houston

MRI scans provide the most detailed information about disc pathology by showing soft tissue structures that X-rays cannot visualize. On MRI, I look for annular tears appearing as high-intensity zones in the disc wall, disc desiccation showing as darkened signal, and herniations where nuclear material extends beyond normal disc boundaries.

Clinical exam findings correlate with dermatomal patterns when disc pathology compresses specific nerve roots, helping confirm that imaging findings explain symptoms. X-rays reveal arthritis-related changes, including facet joint hypertrophy, bone spurs called osteophytes, and narrowed spaces between joint surfaces. When evaluating chronic spine pain, I focus on identifying the true disc-level pain generator through detailed imaging interpretation combined with symptom patterns and examination findings.

Some patients show both disc degeneration and facet arthritis on imaging, which requires careful clinical correlation to determine which structure generates their primary symptoms. My expertise in disc pathology allows me to identify subtle annular tears and inflammatory changes that may be overlooked but represent the actual source of persistent pain.

If you’re interested in why you may experience L5-S1 pain and its causes, symptoms, and treatment, discover more at our clinic.

One Patient’s Experience

I’ve worked with many patients who spent months—sometimes years—receiving treatment for the wrong diagnosis, simply because no one took the time to determine whether their pain originated from disc pathology or facet arthritis.

One Houston-area patient came to Performance Pain and Sports Medicine after being told by multiple providers that her chronic back pain was simply “arthritis” and that she should accept it as part of aging. She had tried physical therapy, anti-inflammatory medications, and even injections, but nothing provided lasting relief. Her pain was limiting her ability to work and disrupting her sleep.

Through detailed imaging review and clinical examination, I identified that her pain actually originated from disc pathology—specifically, annular tears that had never healed. This explained why arthritis-focused treatments hadn’t worked. Once we understood the true source of her pain, we could develop an appropriate treatment plan that addressed the actual biological problem.

This is one patient’s experience; individual results may vary.

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Accurate diagnosis through detailed imaging review and clinical examination provides the foundation for effective treatment, whether that involves conservative care or advanced interventional options for confirmed disc pathology.

Learn more about how Discseel® reviews are helping patients achieve lasting back pain relief and see if this approach fits your needs.

If you’re in Houston, explore our nearby location for treatment.

Conclusion

Understanding whether your back pain is arthritis or a disc issue requires expert evaluation that combines detailed imaging interpretation with clinical examination. As a quadruple board-certified physician focused on disc-related spine conditions, I’ve seen how accurate diagnosis transforms treatment outcomes by ensuring interventions target the actual pain generator rather than addressing the wrong structure.

Comprehensive diagnostic assessment distinguishes between facet arthritis and discogenic pathology, guiding whether conservative care, interventional procedures, or biologic disc repair offers the most appropriate path forward. For patients with confirmed discogenic pain who haven’t improved with conservative treatment, minimally invasive approaches like the Discseel® Procedure may help repair damaged discs in appropriately selected candidates.

My training as a Discseel® Master Instructor allows me to evaluate whether this mechanism-based option addresses your specific disc pathology. Serving patients from Southside Place and surrounding areas in Houston, Performance Pain and Sports Medicine provides the specialized diagnostic expertise needed to identify the true source of your pain. If you’re ready to understand the true source of your pain in Houston, schedule your visit with us today.

To read more about managing L4-L5 pain symptoms or the guide to spinal disc tears, causes, and treatment options, visit our comprehensive resources.

This article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

Frequently Asked Questions

What symptoms suggest disc pain versus arthritis pain?

Disc pain typically worsens with sitting, forward bending, or lifting because these activities increase pressure within the disc and stress annular tears. This pain may radiate into the buttocks or legs in specific dermatomal patterns when nerve roots become irritated. Arthritis pain usually increases with backward bending, twisting, or prolonged standing that compresses facet joints, and often improves with sitting or forward bending.

Morning stiffness that eases with movement suggests arthritis, while pain that intensifies throughout the day points toward disc pathology. These patterns provide diagnostic clues, but accurate identification requires physician evaluation and imaging correlation.

Find additional insights in our article on herniated disc symptoms, causes, and treatment.

Can imaging definitively tell me whether I have arthritis or a disc problem?

MRI scans reveal disc-specific pathology, including annular tears appearing as high-intensity zones, disc desiccation showing as darkened signal, and herniations where nuclear material extends beyond normal boundaries. X-rays show arthritis-related changes such as facet joint hypertrophy, bone spurs, and narrowed joint spaces.

However, many patients show both disc degeneration and facet arthritis on imaging, which requires careful clinical correlation to determine which structure generates primary symptoms. My expertise in disc pathology allows me to identify subtle annular tears and inflammatory changes that represent the actual pain source, ensuring treatment targets the true problem rather than incidental imaging findings.

See our comprehensive guide to L5-S1 bulging disc for details on MRI and disc pain.

What should I do if conservative care hasn’t helped my back pain?

When conservative treatment fails to provide adequate relief, an accurate diagnosis becomes essential to determine whether your pain originates from disc pathology or facet arthritis. Persistent pain despite appropriate conservative care may indicate structural disc damage that requires interventional approaches. I perform a detailed diagnostic evaluation, including advanced imaging interpretation and clinical examination, to identify the true pain generator.

For patients with confirmed discogenic pain related to annular tears, biologic disc repair options like the Discseel® Procedure may be considered in appropriately selected candidates. The key is matching treatment to the actual biological problem rather than continuing ineffective approaches based on incomplete diagnosis.

You’ll find more about the best painkiller for a herniated disc and additional treatment options on our website.

Where can I find an expert diagnosis for back pain in Houston?

At Performance Pain and Sports Medicine in Houston, Dr. Matthias Wiederholz provides specialized diagnostic evaluation for patients struggling to understand whether their back pain stems from disc pathology or spinal arthritis. As a quadruple board-certified physician with expertise in disc-related conditions and training as a Discseel® Master Instructor, Dr. Wiederholz performs comprehensive imaging interpretation combined with detailed clinical examination to identify the true source of your pain.

This accurate diagnosis ensures that treatment recommendations address the actual biological problem, whether that involves conservative care, interventional procedures, or advanced biologic disc repair options for appropriately selected candidates with confirmed discogenic pain.

If you have questions about effective treatment options for L5-S1 disc herniation pain or want to learn how diagnosis is matched to therapy, explore our resources or contact our office here.