In acute sciatica, exercise and conservative approaches provide improvements in pain however, no single intervention demonstrates clear superiority.
Context
- To compare and rank the effectiveness of nonsurgical interventions for reducing pain and disability in adults with acute and subacute sciatica.
Methods
- Randomised controlled trials involving adults with acute or subacute sciatica were identified through systematic database searches (Embase, MEDLINE, Cochrane Library, CINAHL).
- 40 randomised controlled trials were included, comprising 5,381 participants.
- Interventions assessed included exercise therapy, manual therapy, traction, electrotherapy, medications, injections and advice or usual care.
- A network meta-analysis was conducted to allow both direct and indirect comparisons across interventions.
- Outcomes measured were pain intensity and disability in the short term
Results
- The evidence showed small and clinically modest effects for most interventions.
- Exercise-based and multimodal care ranked slightly higher for pain and disability outcomes
- Many commonly used treatments showed no clear advantage over advice or usual care.
- No intervention demonstrated large or consistent benefits across outcomes.
Reference
Pinto, R. Z., Maher, C. G., Ferreira, M. L., Hancock, M. J., Oliveira, V. C., McLachlan, A. J., & Ferreira, P. H. (2025). Effectiveness of nonsurgical interventions for patients with acute and subacute sciatica: A systematic review with network meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 55(6), 407–418.
