Sciatica: Enhancing the Effectiveness of Exercise Therapy



About 60% of patients seeking primary care for back pain also report associated leg pain, which can include sciatica from nerve root entrapment and referred pain without nerve involvement. Those with leg pain generally experience worse outcomes than those with back pain alone.1-2

Traditionally, sciatica was viewed as a self-limiting condition. However, recent studies highlight high recurrence rates, functional decline, and rising healthcare costs. The ATLAS study found that only 55% of patients showed significant improvement in disability after 12 months, while only 27.6% of those receiving standard care reported success after a year.3 In contrast, patients referred to physiotherapy were 60% more likely to achieve positive outcomes.

While core strengthening has been a common recommendation for low back pain, recent research from Saveetha College of Physiotherapy explored the effectiveness of different exercise therapies for sciatica.4 Patients with nerve root compression were divided into two groups: one focused on core strengthening exercises, and the other on stretching and posture correction. Both groups received TENS for pain relief and engaged in six weeks of exercise therapy.

Both approaches led to statistically significant improvements, with the core strengthening group improving from a score of 50 to 34 (32% improvement), and the posture correction group improving from 50 to 21 (58% improvement).

These findings indicate that prioritizing posture correction and stretching could lead to better outcomes than focusing exclusively on core strengthening.

References

  1. Hill JC, Konstantinou K, Egbewale BE, Dunn KM, Lewis M, van der Windt D. Clinical outcomes among low back pain consulters with referred leg pain in primary care. Spine. 2011 Dec 1;36(25):2168-75.
  2. Konstantinou K, Hider SL, Jordan JL, Lewis M, Dunn KM, Hay EM. The impact of low back-related leg pain on outcomes as compared with low back pain alone: a systematic review of the literature. The Clinical Journal of Pain. 2013 Jul 1;29(7):644-54.
  3. 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.
  4. van Tulder M, Peul W, Koes B. Sciatica: what the rheumatologist needs to know. Rheumatology. 2010; 6: 139-145.
  5. 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.



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