Physiotherapy in Sciatica Management: Current Insights and Future Directions

Abstract

Sciatica, a condition characterized by pain radiating from the buttock down the course of the lumbosacral nerve roots, is a common and often debilitating condition. While the reported prevalence and incidence vary due to differences in definitions and data collection methods, estimates suggest a significant burden on healthcare systems and economies worldwide. Sciatica is mostly caused by a herniated lumbar disc, resulting in nerve root compression and inflammation. Diagnosis relies on a combination of patient history and physical examination findings, with routine imaging not recommended unless specific underlying causes are suspected. Conservative management is the initial approach, focusing on patient education, advice to remain active, and exercise therapy. Spinal manual therapy may provide short-term benefits, but guideline recommendations vary due to the limited persuasiveness of evidence. Medication use for sciatica remains uncertain, as most medications provide limited additional benefits compared to placebo and carry the risk of significant side effects. Surgical intervention may be considered when conservative management fails to yield significant improvement, offering modest short-term benefits in pain relief and functional outcomes. Future research should focus on understanding the pathogenic role of inflammation, refining classification systems, and integrating clinical findings, biomarkers, and physical assessments to improve diagnostic and therapeutic approaches. Optimizing physiotherapy care for sciatica requires a patient-centered approach that incorporates emerging evidence and addresses individual preferences to ensure effective and sustainable management.