The term “sciatica” is not clearly defined and it is often used inconsistently by clinicians and patients. 2 3 4 In this Clinical Update, we provide an overview for non-specialists on diagnosing sciatica and key principles in its management. Recently updated clinical guidelines in Denmark, the US, and the UK highlight the role of conservative treatment for sciatica. 1 Sciatica can cause severe discomfort and functional limitation. It is caused by inflammation or compression of the lumbosacral nerve roots (L4-S1) forming the sciatic nerve. Sciatica is commonly used to describe radiating leg pain. It may speed up recovery but the effect is similar to conservative care at one year Surgery is an option if symptoms do not improve after 6-8 weeks of conservative treatment. Urgently refer patients with signs of urinary retention or decreased anal sphincter tone, which suggest cauda equina syndrome Imaging is not required to confirm the diagnosis and is only requested if pain persists for more than 12 weeks or the patient develops progressive neurological deficits Most patients improve over time with conservative treatment including exercise, manual therapy, and pain management Sciatica is a clinical diagnosis based on symptoms of radiating pain in one leg with or without associated neurological deficits on examination
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