Getting confident with sciatica: a reading list
Useful and readable sources for MSK clinicians
This reading list is designed to help you 1) get the basics, and 2) develop a lasting interest in lumbar radicular pain, often called sciatica.
It avoids overly technical papers and focuses on sources that are readable and useful.
⭐️ = the main thing to read; if you just read all the starred sources, you’ll get most of what you need and it will only take an afternoon.
Terminology and presentation:
⭐️ Bogduk’s classic paper for the difference between radicular pain, referred pain and radiculopathy. Shorter version: this blog post
Smyth & Wright’s famous ‘tugging on nerve roots’ paper is one of the most memorable ways to understand sciatica. Shorter version: this blog post.
Anatomy:
There are lots of very involved papers about how big dorsal root ganglions are or the exiting angle of nerve roots. It’s all synthesised here.
Nerve-side pathophysiology:
⭐️ This paper by Gifford is the most readable source. It’s about cervical radicular pain, but the principles are the same. There are other papers (like Lin, Dower) that are newer and more comprehensive, but they are hard to follow and don’t get at the gestalt.
For more depth, try Schmid et al. on entrapment neuropathies in general, or, with some risk of getting bogged down, Olmarker.
On neuropathic pain, most papers are overwhelming; try this to understand nerve ‘hot spots’.
Our book, but I would say that.
Disc-side pathophysiology:
⭐️ Fardon et al. classifications (the difference between protrusion, extrusion, etc.)
Adams and Dolan are always readable and fair, the best one to start with is probably this one.
For the truth behind the myths (and counter-myths), on symptoms there’s What Do We Actually Know About Disc Herniations? and on causes there’s Herniation Wars or Does Bending and Lifting Cause Disc Herniations?
It’s not always a disc, of course. On stenosis, there are more modern reviews, but reading Porter’s papers on central and lateral stenosis is probably just as useful and more fun.
Prognosis:
My summary, 4-6 schmeeks, shows how patients are misled by overly optimistic timeframes.
Patients’ experiences:
⭐️ Rob Goldsmith’s paper - patients want to understand.
Ryan and Roberts’ “Life on Hold” is another good place to start.
Livingwellpain.net is a blog by an expert patient with sciatica - all posts aimed at clinicians are here.
Mayer, ‘Pain Behavior’, to appreciate just how bad it can be.
Assessment:
⭐️ Schmid & Tampin’s textbook chapter, free here.
Grimm et al. on mimickers is a good read.
Youtube interview on assessing sciatica.
Cauda Equina Syndrome:
⭐️ The GIRFT guidance is short and vital.
Lavy et al. clears up a lot of common confusions.
Youtube interview on CES.
Treatment:
On conservative care, for an idea of how little there is for us to go by, read Lucy Dove’s review, or here is our paper.
⭐️ Basic rehab principles, articulated here by Greg Lehman, will get you far. Pair with a decent explanation that sciatica is not just (or even mostly) compression, but also inflammation.
PainScience on neurodynamics.
There’s not much that’s fun to read on medical/surgical treatment. The NICE guidelines are your best bet (but, on meds, see also).
Historical:
Not essential, but often more vivid and enlightening than modern papers:
Mixter & Barr in the 1930s discovering that the tumors they thought they were excising at surgery were actually disc herniations.
History of the discovery of disc herniations.
Kuslich, along with Smyth & Wright another ‘couldn’t do that these days’ study.
Falconer’s early, incredibly clear-minded observations here and here. O’Connell’s, too.