HealthDay News — Active conservative symptom-guided therapy for severe sciatica can safely reduce pain and improve neurological function at a rate that matches or surpasses outcomes from common higher-cost surgical interventions, results of a Danish study suggest.

“Active conservative treatment was effective for patients who had symptoms and clinical findings that would normally qualify them for surgery,” Hanne B Albert, MPH, PhD, and Claus Manniche, MD, PhD, of the University of Southern Denmark in Ringe, reported in Spine.

They conducted a prospective, single-blind, randomized, controlled study of 181 consecutive patients with back pain that radiated below the knee for at least two weeks. The researchers were randomly assigned to a group given symptom-guided exercise that targeted below-the-knee pain (algorithm available, here) or to a group assigned to sham exercises that improved general blood circulation. Each group also received information and advice to stay active.

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The average patient age was 45 years and the majority had disc herniations. Patients received an average 4.8 treatment sessions during the study period. Primary outcome measures were based on Roland-Morris Disability Questionnaire and a 10-point leg pain scale.

At one year, all patients experienced statistically significant and clinically important improvements in global assessment, functional status, pain, vocational status and clinical findings, the researchers found. Approximately 90% reported that they were better or much better at one year, with average pain scores decreasing from 4.4 to 1.4 on a 10 point scale during the course of a year.

Although there were no clinically significant differences in outcomes between the two groups on primary outcome measures, the symptom-guided exercise group reported a higher level of general satisfaction and greater improvement in neurological findings.

“This is yet another paper that documents the generally good natural history of lumbar radiculopathy in younger patients and makes it clear that it is safe to treat these patients without surgery,” associate web editor, Adam Pearson, MD, MS, wrote in an accompanying editorial.

However, Pearson pointed out that the study did not compare symptom-guided exercise to surgery and that the vast majority of patients who experience pain for less than four weeks often get better without treatment. The study also does not address the mechanism of action behind the benefits associated with symptom-guided exercise.

“Regardless of the mechanism, this study should help clinicians inform their younger sciatica patients that they have a very high likelihood of improving without surgery,” Pearson concluded.

Albert HB, Manniche C. Spine. 2012;37(7):531–542.

Pearson A. “Do Symptom Guided Exercises Actually Help Sciatica?” The Spine Blog. April 7, 2012.