Sciatica is a painful condition with symptoms of pain, numbness, and/or pins and needles extending down the leg. The term sciatica is helpful for location of symptoms, but their are multiple causes of sciatica. In our Boulder Physical Therapy and Lafayette Physical Therapy clinics, determining the cause is the first step in recovery for this condition. Patients with sciatica symptoms are effectively treated with Physical Therapy interventions including manual therapy, exercise, and education. A small subset of patients may require a steroid injection to complement the Physical Therapy interventions as part of conservative treatment approach for this condition. A recent review of the medical evidence compared the effectiveness of conservative treatment interventions to surgery for patients with sciatica.
Liu and colleagues published the findings of their review on the effectiveness of conservative and surgical interventions for patients with sciatica in the British Medical Journal (2023). Authors included 24 trials including treatments of conservative treatment (Physical Therapy and steroid injections) and surgery (discectomy) in over 1700 patients. They reported very low certainty evidence that surgery improved leg pain more than conservative treatment in the short term. Negligible differences were noted for leg pain at long term follow up or disability. Given the lack of evidence supporting surgery over conservative treatments, including Physical Therapy, patients are encouraged to utilize conservative treatments first before surgery.