Thank you for such a wonderful article! It would be great if you can share your opinion on the following points:
1. As you mentioned in the article, 1/3 of the people sciatica will have their symptoms stay the same or even worse after 4-6 weeks. Would you advise early surgery to patient if there is no improvement in 4-6 weeks? Or would you wait till 3-4 months of conservative treatment? ( Obviously, patient preference and other factors play a huge role, but lets just discuss it in a vacuum)
2. While I understand why you say that it is a clinical course but not a natural history of sciatica due to the research design, is the true natural history of Sciatica going to be really similar to what you shown here ? Given that physiotherapy effect on sciatica is quite modest according to your own narrative review.
1. As you say, there is more to say about the decision for surgery than I can put in one comment.. but on the whole yes I agree with the advice to wait 4-6 weeks for things to improve, and also the general wisdom that 3-4 months is starting to get too long (if it's serious enough to consider surgery, it's too long to make someone suffer), especially as there is a little bit of evidence that surgery is less effective the longer it is postponed. Now, if you're in England, good luck getting even a GP appointment in that time :)
2. Yes I suspect the true natural history of sciatica is not too different to what we would see if it was being treated conservatively. I think there is a huge role to play for physio, or any good clinician, for certain people who are going in the wrong direction and doing the wrong things (e.g. avoiding activity, return to work etc.), and for helping people to stay comfortable and maintain hope while natural history does its thing. But on the whole I suspect a conservatively treated group trajectory is probably a good indicator of the trajectory of a hypothetical group who never receive treatment.
I always thought about 80%people with radicular pain would begin to 'improve' by 3 to 4 months, so not far off. I'm interested to hear about the 3 to 4 months from when. The article suggests from when treatment begins rather than from onset of the radicular pain. I guess then what constitutes treatment?
Great post, definitely think these are a big step up from twitter comments! Great figure from the ATLAS study
Cheers Conor!
Thank you for such a wonderful article! It would be great if you can share your opinion on the following points:
1. As you mentioned in the article, 1/3 of the people sciatica will have their symptoms stay the same or even worse after 4-6 weeks. Would you advise early surgery to patient if there is no improvement in 4-6 weeks? Or would you wait till 3-4 months of conservative treatment? ( Obviously, patient preference and other factors play a huge role, but lets just discuss it in a vacuum)
2. While I understand why you say that it is a clinical course but not a natural history of sciatica due to the research design, is the true natural history of Sciatica going to be really similar to what you shown here ? Given that physiotherapy effect on sciatica is quite modest according to your own narrative review.
Again thanks for such an awesome article!
Thanks Neo.
1. As you say, there is more to say about the decision for surgery than I can put in one comment.. but on the whole yes I agree with the advice to wait 4-6 weeks for things to improve, and also the general wisdom that 3-4 months is starting to get too long (if it's serious enough to consider surgery, it's too long to make someone suffer), especially as there is a little bit of evidence that surgery is less effective the longer it is postponed. Now, if you're in England, good luck getting even a GP appointment in that time :)
2. Yes I suspect the true natural history of sciatica is not too different to what we would see if it was being treated conservatively. I think there is a huge role to play for physio, or any good clinician, for certain people who are going in the wrong direction and doing the wrong things (e.g. avoiding activity, return to work etc.), and for helping people to stay comfortable and maintain hope while natural history does its thing. But on the whole I suspect a conservatively treated group trajectory is probably a good indicator of the trajectory of a hypothetical group who never receive treatment.
I always thought about 80%people with radicular pain would begin to 'improve' by 3 to 4 months, so not far off. I'm interested to hear about the 3 to 4 months from when. The article suggests from when treatment begins rather than from onset of the radicular pain. I guess then what constitutes treatment?