Early Physical Therapy for Sciatica?

The role of physical therapy (PT) for managing acute low back pain with sciatica is unclear. In this randomized trial, researchers enrolled 220 patients who presented with back pain, lumbosacral radiculopathy, and symptom duration <90 days (mean, 36 days); confirmation of nerve-root compression by imaging was not required. Patients received 4-week courses of PT (6–8 sessions) or usual care. The nine participating physical therapists focused on lumbar extension exercises, with selective use of manual therapy (i.e., manipulation or mobilization of lumbar spine).

Improvement was greater in the PT group than in the usual-care group; however, mean differences between groups on a standardized 100-point back pain disability index were only 8, 5, an…