Sciatica simply means pain down the back of the leg and was so called because it used to be thought that pain would follow nerve distribution within the body. The term has evolved to mean leg pain. Generally, leg pain occurs with back pain. Back pain with leg pain can be debilitating and excruciating. Medication can be helpful to take the edge off the pain intensity, but not always.

Sciatica does not have a single cause and predictive tests do not yet exist to know if Surgery, Spinal Injection, or Exercise, Manipulation and Goal Setting is best (1). Largely what is done depends upon the opinion and resources of the person with sciatica.

Whilst NHS waiting lists for surgery can be well over the 18-week target for urgent cases, those who have the resources can opt for early surgery (2). A recent systematic review shows that Surgical intervention(s) can improve pain experience by 10 to 20% over other treatments (1) in the first 6 months. Other treatments include pain modifying medication (oral or injectable), exercise, manipulation, CBT or do nothing.

When trying to choose between an active or a passive approach it might provide comfort to know the longer-term indicators in research (1) don’t show any difference in pain and disability at about 3-4 years. Meaning in the long run it doesn’t matter to pain and disability which option you go for.

Manipulation has been shown to help people in Acute and Chronic Back Pain (3) and (MRI confirmed disc) Sciatica (4, 5). Manipulation can loosen you up and improve disability, in the short term, but does little to impact pain levels without rehabilitative movements and step by step goal setting.

At Fascia First Chiropractic the improvement in movement gained from manipulation in the first instance are used to kick start your rehabilitative movements over short time frames with specific goals for you to strive for.

References:

1. Chang Liu et al. (2023) Surgical versus Non-Surgical Treatment for Sciatica. BMJ 2023;381: e070730
2. Schmid AB et al (2023) Early Surgery for Sciatica(?). BMJ 2023;381: p791 (editorial)
3. Rubinstein SM et al (2019) Benefits and Harms of Spinal Manipulative Therapy for the Treatment of Chronic Low Back Pain. BMJ 2019; 364: l689
4. Burton AK, Tillotson KM and Cleary J. (2000) Single Blind Randomised Controlled Trial of ‘Chemonucelolysis’ (Surgery) and (Spinal) Manipulation in the Treatment of Symptomatic Lumbar Disc Herniation. Eur J Spine J2000;9 202
5. McMorland G et al (2010) (Spinal) Manipulation or Microdiskectomy (Surgery) for Sciatica? JMPT 33 (8) 576