title: Physiotherapy and lumbar facet joint injections as a combination treatment for chronic low back pain. A narrative review of lumbar facet joint injections, lumbar spinal mobilizations, soft tissue massage and lower back mobility exercises.
abstract: OBJECTIVE
  The aim of this study was to summarize the available evidence on lumbar facet joint injections and the physiotherapy treatments, land-based lower back mobility exercise, soft tissue massage and lumbar spinal mobilizations for chronic low back pain (CLBP). The plausibility of physiotherapy and lumbar facet joint injections as a combination treatment is discussed.
  
  
  METHODS
  Using a systematic process, an online electronic search was performed using key words utilizing all available databases and hand searching reference lists. Using a critical appraisal tool from the Critical Appraisal Skills Programme (CASP), the literature was screened to include primary research. The main aspects of the research were summarized.
  
  
  RESULTS
  The evidence for lumbar facet joint injections suggests an overall short-term positive effect on CLBP. Land-based lower back mobility exercise and soft tissue massage appear to have a positive effect on CLBP in the short term and possibly in the longer term. There is insufficient evidence to draw conclusions for lumbar spinal mobilizations.
  
  
  CONCLUSIONS
  The review indicates that lumbar facet joint injections create a short period when pain is reduced. Physiotherapy treatments including land-based lower back mobility exercise and soft tissue massage may be of benefit during this time to improve the longer-term outcomes of patients with CLBP. It is not possible to make generalizations or firm conclusions. The current review highlights the need for further research. A randomized controlled trial is recommended to assess the impact of physiotherapy in combination with lumbar facet joint injections on CLBP.
authors.affiliation: Kent and Canterbury Hospital, Kent, UK. hannahchambers1@nhs.net
authors.forename: Hannah
authors.initials: H
authors.lastname: Chambers
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D007270:Injections, Intra-Articular; D017116:Low Back Pain / Q000628:therapy*; D008159:Lumbar Vertebrae; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D021801:Zygapophyseal Joint