Research Review by Dr. Shawn ThistleĀ©

Date:

Jan. 2006

Study Title:

Interventions that increase or decrease the likelihood of a meaningful improvement in physical health in patients with sciatica

Authors:

Jewell DV, Riddle DL

Public Information:

Physical Therapy 2005; 85(11): 1139-1150.

Summary:

There have been numerous studies about physical therapy interventions for low back pain. Unfortunately, another clinical problem, sciatica, has not received as much attention or has been lumped in with other low back pain conditions in clinical trials. Although low back pain and true sciatica often coexist, the experienced clinician will know that there is often much confusion from patients about what sciatica is.

Most patients assume any pain the leg, anywhere in the leg, is sciatica. In reality, true sciatica, defined as irritation of the sciatic nerve causing characteristic referral of pain down the leg in the sciatic nerve distribution, is not as common as many think. Lifetime incidence of sciatica is reported to be anywhere between 2-40% (whereas low back pain is still reported to be ~80%). Nonetheless, it does occur, and can be a difficult condition to treat.

Previous studies done specifically on sciatica have indicated that there is wide variance in the methods used by physical therapists to treat sciatica. This study attempted to isolate sciatica as a clinical entity, and determine if any physical therapy interventions have a meaningful impact on improvement in these patients.

1804 patients (average age 52 years) diagnosed with sciatica were included in the study using data from Focus On Therapeutic Outcomes Inc (FOTO), a private rehabilitation outcomes management company. At total of 910 therapists participated in the study, and standardized forms were utilized to gather clinical information and record treatment interventions. The primary outcome measure used to measure treatment impact was the Physical Component Summary-12, a pencil and paper questionnaire developed from the Physical Component Scale of the Short-Form Health Survey Questionnaire 36 (SF-36).

On average, therapists used 8.26 different interventions in a course of care. To be included in the analysis, 5% of patients in the sample had to receive a certain treatment. A total of 23 different treatment options were included in the analysis, and were collapsed into 8 groups based on similarity (for example, the exercise intervention group included stretching, strengthening, and other flexibility exercises).

Pertinent Results:

  • after statistically adjusting for age, length of time since condition onset, and PCS-12 score at admission, joint mobility and exercise interventions increased the likelihood of a meaningful improvement
  • conversely, the use of spasm reducing intervention decreased the likelihood of a successful outcome
  • when combined, joint mobility interventions in the absence of exercise were most effective, despite more patients receiving exercise as part of their treatment
  • of note, spinal manipulation was NOT included in this study (it did not fulfill the 5% criteria outlined above)
  • most passive treatment modalities actually hindered patient recovery
  • the most common intervention was exercise, indicating that physical therapists still rely heavily on this treatment modality

Conclusions & Practical Application:

This study suggests that joint mobility and exercise interventions can have a meaningful impact on patients with sciatica. This is one of the first studies to investigate sciatica as an isolated condition, and provides an interesting framework for future work in this area.

There are some potential limitations of this study that should be noted:
  1. patients were chosen in a non-random fashion
  2. the sample was trimmed to include patients with sciatica but without coexisting conditions
  3. details of patient files were not available to clarify interventions - all data was taken from standardized forms
Future research should continue to focus on which combinations of therapeutic modalities are most effective for treating sciatica, as well as investigating some treatment modalities not included in this study (such as spinal manipulation).