From the Guidelines
Physiotherapy is a crucial component in the management of sciatica, as it addresses the root causes of the condition and improves patient outcomes. When managing sciatica, it is essential to consider the limited evidence on optimal sequencing of interventions and methods to guide selection of therapy for individual patients 1. The current evidence suggests that several noninvasive therapies, including physiotherapy, seem to be similarly effective for chronic low back pain, which is often associated with sciatica. Key factors to consider when choosing among noninvasive therapies are patient preferences, cost, convenience, and availability of skilled providers for specific therapies. Some studies have found that adding one noninvasive intervention to another may not provide additional benefit, although acupuncture plus another therapy has been found to be more effective than the other therapy alone 1. In terms of specific physiotherapy interventions, gentle stretching exercises, core strengthening exercises, and low-impact aerobic activities can help improve spinal alignment, strengthen supporting muscles, and enhance flexibility. For example, exercises focusing on the piriformis muscle, hamstrings, and lower back can help reduce pressure on the sciatic nerve. It is also important to note that the natural history of acute low back pain is for substantial early improvement in most patients, and evidence on effectiveness of therapies specifically for subacute low back pain is sparse 1. Therefore, a comprehensive physiotherapy program that incorporates a combination of exercises, heat and ice therapy, and education on proper posture and body mechanics is recommended for the management of sciatica. This approach can help improve patient outcomes, reduce pain and inflammation, and enhance quality of life. Incorporating physiotherapy into the management plan can also help reduce the need for pharmacologic interventions and minimize the risk of adverse effects. Overall, physiotherapy is a valuable component of a multidisciplinary approach to managing sciatica, and its benefits should not be overlooked.
From the Research
Role of Physical Therapy in Sciatica Management
- Physical therapy is often prescribed as a first-line treatment for people with sciatica, but its effectiveness remains controversial 2
- A systematic review and meta-analysis found no significant difference in pain and disability between physiotherapy interventions and control interventions in the short, medium, and long term 2
- However, subgroup analysis of studies comparing physiotherapy with minimal intervention favored physiotherapy for pain at long-term time points 2
Effectiveness of Physical Therapy in Reducing Disability
- A randomized controlled trial found that early referral to physical therapy reduced disability more than usual care alone for patients with acute sciatica 3
- The trial showed that participants in the early physical therapy group had greater improvement in the Oswestry Disability Index score after 6 months and 1 year compared to the usual care group 3
- Another study found that a combined nonsurgical management program including McKenzie physiotherapy, gabapentin, and periradicular injections was effective in reducing pain and improving quality of life for patients with sciatica due to lumbar disc herniation 4
Comparison of Stratified Care and Usual Care
- A randomized controlled trial compared stratified care (which included physiotherapy) with usual care for patients presenting with sciatica in primary care, and found no significant difference in time to symptom resolution between the two groups 5
- The trial also found that stratified care was not cost-effective compared to usual care 5
Epidemiology and Pathogenesis of Sciatica
- Sciatica is a frequent and often debilitating condition, with a lifetime incidence estimated to be between 13% and 40% 6
- The condition is often caused by herniation of one or more lumbar intervertebral discs, and can be influenced by factors such as increasing height, age, genetic predisposition, and physical occupations 6
- Physical therapy, including physiotherapy, is often used as a treatment for sciatica, and can be effective in reducing pain and improving quality of life 2, 3, 4