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Does PT for Sciatica Make a Difference?

November 24, 2020

Written by Kevin Stoffer

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In outpatients with acute sciatica, physical therapy (PT) had a statistically but not clinically significant effect on patient disability compared with usual care.

Why does this matter?
NSAIDs improve low back pain. Adding Tylenol to ibuprofen does not add benefit. Muscle relaxers and opiates do not change outcomes either.  Early activity and exercise has shown improvement in symptoms, so what if PCPs or ER docs referred these patients to PT?

PT for acute sciatica? Backing out slowly…
In this assessor-blinded RCT comparing 4 weeks of PT to usual care for acute sciatica in adult patients, authors studied patient disability at 6 months, as measured by the Oswestry Disability Index (ODI).  All patients were healthy at baseline and had no red flags requiring further imaging or ED visit. They found a statistically significant difference favoring PT; mean ODI difference -5.4 points (95%CI −9.4 to −1.3).  However, it’s puzzling why they concluded, “physical therapy for recent-onset sciatica improved disability,” when they established in advance that the minimum clinically important difference in ODI was 6 to 8 points. They were short of that. In fact, both groups decreased from moderate to minimal disability. Other outcomes showed no difference in surgical consultation, further imaging studies, or decrease in opiate/pain medication usage.

As one who suffers from sciatica, this study does not convince me of the benefit of PT.  I think I’ll stick with my ibuprofen and exercise.

Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica : A Randomized Controlled Trial. Ann Intern Med. 2020 Oct 6. doi: 10.7326/M20-4187. Online ahead of print.

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What are your thoughts?