A recent RCC Research Bulletin highlighted the comparative effectiveness of spinal manipulation for sciatica. The findings outlined in the bulletin are compatible with the ‘Pathfinder’ Pathway of Care for Low Back and Radicular Pain (NHS England, 2014) which provides a generic pathway for the management of low back and radicular pain based on a consensus of all stakeholders.
The pathway identifies manual therapy (manipulation) and acupuncture as appropriate for radicular pain where there is pain and/or sensory deficit; however, emergency surgical referral is required for suspected spinal cord or cauda equina syndrome. Urgent referral for MRI or surgical opinion is also required for suspected tumour, infection or severe or progressive motor deficit (e.g. foot drop) and MRI is recommended if a patient fails to improve with conservative therapy.