This is part 1 in a series of 3 on active conservative treatment of sciatica.
Studies have shown that conservative treatment can be just as effective as surgery in treating patients with low-back pain and sciatica. (1) But methods of conservative treatment can vary widely from chiropractic adjustments to epidural injections (other treatments include mobilization, rest, exercise, and traction). Even within a single profession, treatment methods and practices are highly variable. So what types of conservative treatment are most effective in treating patients with severe sciatica? That’s what researchers hoped to answer in a recent study published in the prestigious journal Spine.
In this study conducted in Denmark, 181 patients with severe sciatica were randomly assigned to one of two active conservative treatment methods. Over the course of 8 weeks, one group performed symptom-targeted exercises and the other group optionally performed more general exercises to increase blood circulation. Both groups received information about the anatomy of the spine, herniated discs, and the natural healing process without surgery. Patients were encouraged to stay as active as possible with respect to their pain thresholds, and were notified about the generally positive prognosis of sciatica. Treatment was provided by chiropractors and physiotherapists.
All of the participants experienced significant improvements in their overall condition with improved functioning, decreased sick days as a result of pain, and reduced sciatica nerve compression. However, patients in the symptom-targeted exercise group had greater benefits overall: they scored better on overall assessments of their condition, had less sick days, and more improvements in terms of nerve compression. Clearly, symptom-targeted exercises were more effective for patients with severe sciatica in this study.
The high success rate of both groups led researchers to conclude that active conservative treatment can be effective even for patients with severe forms of sciatica. This study demonstrates that the nature and type of conservative treatment significantly impacts outcomes.
(1) McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.” Journal of Manipulative and Physiological Therapeutics. 2010; 33(8): 576-584.
Albert, HB and C. Manniche. “The efficacy of systematic active conservative treatment for patients with severe sciatica.: A single-blind randomized clinical controlled trial.” Spine (April 2011). doi: 10.1097/BRS.0b013e31821ace7f.