Sciatica: More Persistent Than Many Realise

Sciatica refers to pain down the sciatic nerve, which runs from the low back down the back of each leg. It’s commonly held that patients recover in four to six weeks, usually without surgery

However, this often-repeated prognosis lacks a firm evidence-based foundation. A recent prospective cohort study of 609 patients found that after a year, only about half of patients reported full recovery.(1) Sciatica cannot be counted on to go away on its own and merits an evidence-based intervention.

Sciatica tends to affect people age 30 to 50. However, among patients age 62+, as long as the sciatica is allowed to persist, there is a two-fold greater risk of accidental falls.(2)

How effective is physiotherapy? Research shows that physiotherapy must be active and individualised to be fully effective. In one study, 180 patients who qualified for surgery due to sciatica were randomised into a professionally guided exercise therapy group or a general cardiovascular fitness group. The physiotherapy group received only five visits over eight weeks. After one year, the physiotherapy group showed greater improvement in most measured outcomes including pain, functional status, and findings from their doctors. The physiotherapy group spent less time off work and they were 20% more likely to report sustained recovery. Study participants in the cardio exercise group proved five times more likely to elect surgery than the patients who received some physiotherapy.

Physiotherapy will influence the consequences of neural impingement such as loss of physical fitness, neural mobility, and spinal range of motion. Furthermore, we can ensure that the problem is not perpetuated by poor ergonomics and posture. When surgery is required, physiotherapy is an important part of the recovery process ensuring that exercise type and intensity are appropriate to the stage of the recovery.

References:

Konstantinou K, Dunn KM, Ogollah R, Lewis M, van der Windt D, Hay EM, ATLAS Study Team. Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort. The Spine Journal. 2018 Jun 1;18(6):1030-40.
Hicks G, Gaines J, Shardell M, et al. Associations of back and leg pain with health status and functional capacity of older adults: findings from a retirement community back pain study. Arthritis and Rheumatism. 2008; 59: 1306-1313.
Nordin M, Belague F. Exercise may be beneficial for patients with chronic, severe sciatica who would normally qualify for surgery. Evid Based Med. 2013; 18 (2): 63-64.