Immediate Physiotherapy for Sciatica May Be the Way to Go

How Do Patients Feel About Usual Care for Sciatica?

Sciatica refers to pain down the sciatic nerve, which runs from the low back down the back of each leg. It is commonly associated with back pain. Last month, we reported on studies finding that sciatica is much more persistent than healthcare professionals may have realised. A study out of the U.K. found that one year after seeing a primary care provider, only about half of patients achieved treatment success. In that study, treatment success was defined as a mere 30% improvement in a disability questionnaire, but would a patient define that as success? This past October, a separate study with similar findings came out of the U.S.(1) When they simply asked patients with sciatica if the treatment was successful, only 27.6% of patients felt like the answer was “yes,” even after a year of “recovery.”

The Traditional Treatment Approach for Sciatica

The traditional strategy for helping patients with sciatica is a stepped approach.(2) A primary care provider would start by offering pain medications. If the patient returns with the same complaint at a later date, the primary care provider may offer physiotherapy. Persistent cases with repeat visits to providers may eventually receive recommendations for surgery. This approach is based on the idea that sciatica mostly resolves on its own in a matter of weeks and that recurrence is not an important consideration. Since we now have evidence that sciatica is not self-resolving in a high percentage of cases, should we also be reconsidering the stepped approach toward treatment?

Starting Meaningful Sciatica Treatment Right Away

That study out of the U.S. finds evidence in support of giving patients immediate access to more than just medicine to quiet the pain. Dr. Julie Fritz and colleagues randomized 220 sciatica patients into a usual care group versus a group that received a referral to physiotherapy at the first primary care visit. The physiotherapy group enjoyed significant improvements in disability measures after four weeks and proved 60% more likely to self-report treatment success at one year.

In Dr. Fritz’s study, the physiotherapy programmes consisted of six to eight supervised exercise sessions spread over four weeks, along with a home exercise plan that patients can perform independently. Treatments focused on lumbar extension and hands-on therapy such as spinal mobilisation and manipulation.   

Conclusion

The evidence suggests that we cannot expect sciatica to go away on its own and then stay gone in the majority of cases. Starting physiotherapy right away improves outcomes, even after a year.  

References

1. Fritz JM, Lane E, McFadden M, Brennan G, Magel JS, Thackeray A, Minick K, Meier W, Greene T. Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica: A Randomized Controlled Trial. Annals of Internal Medicine. 2020 Oct 6.
2. Lewis RA, Williams NH, Sutton AJ, Burton K, Din NU, Matar HE, Hendry M, Phillips CJ, Nafees S, Fitzsimmons D, Rickard I. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. The Spine Journal. 2015 Jun 1;15(6):1461-77.