Sciatica. Management for family physicians

Abstract

Sciatica or lower back pain with sciatic radiation is a frequent medical problem in primary care. The aim of this article is to better inform medical practitioners on diagnosis and management of lower back pain with sciatic radiation. Updated information on sciatica management is important for family physicians. Here, we review the available literature on sciatica. Relevant articles were identified via a literature search in PubMed by focusing on the following key points: diagnostic and definition criteria, red flags, and therapy. In addition, the authors’ clinical experience has been utilised to propose a schema to assist in the assessment and treatment of sciatica in a primary care setting. Sciatica diagnosis is based on a careful history and clinical examination. Imaging is usually not necessary at first; testing with X-ray and MRI are key to diagnosing lumbar instability and herniated discs. Management includes physical conditioning, proper pain management, and surgery as a last resort. Pain treatment includes analgesics, anticonvulsants and muscle relaxants. A more aggressive approach would include epidural infiltrations and radiofrequency.

Effects of Neurodynamics Along With Conventional Exercises on Sciatica Patients: A Single-Blinded Randomized Clinical Trial

“…This makes the patient feel to have improved HRQL. Another possibility is that the psychological aspect of patients also improves when the fear of pain reduces and daily activities feel easy [ 3 ].…”

“…In this study, we tried to find out the differences between the effects of neurodynamic mobilization combined with conventional exercises and conventional exercises alone. Studies suggest the long-term application of conventional exercises to get their effects [5][6][7], and the application of neurodynamic mobilizations and other manipulative therapy as an alternative treatment [3,9]. The studies tried to find out the effects of the combination of neurodynamic mobilization and conventional exercises when applied for a shorter duration.…”

“…Physiotherapy treatments are usually considered the first line of treatment for sciatica patients [ 3 ]. Physiotherapists usually prefer to treat LBP with sciatica using various exercises and electrotherapy treatments [ 4 ].…”

The piriformis muscle syndrome – anatomy, diagnosis and the role of physiotherapy. A Review

“…Pain can be described or associated with burning, heaviness, or pressure sensation. The extent of irritation or damage to the sciatic nerve progresses from pain-paresthesia to motor impairment, which means an increase in nerve damage [41].…”