Effects of neural tissue management added to advice to stay active on pain and function of patients with chronic sciatica: A randomised controlled trial

Abstract

Introduction: Patients with sciatica have a worse prognosis when compared to patients with localised low back pain. Advice to stay active is the main treatment strategy for low back pain. However, a treatment based on neural management can contribute to recovery from sciatica. Objective: To compare the effects of adding neural management to advice to stay active on pain intensity and functional limitation in patients with chronic sciatica. Methods: A randomised controlled clinical trial will be conducted in 210 participants with chronic sciatica, aged between 18 and 65 years. Recruitment will take place at the physiotherapy clinic of the Augusto Motta University Centre (UNISUAM) and from community advertisements. The experimental group will receive techniques of neural management and soft tissue mobilisation for 10 weekly sessions, in addition to advice to stay active for 5 fortnightly sessions. The control group will receive only the advice to stay active protocol. Reassessments will be performed at 5, 10, and 26 weeks after randomisation. The primary outcome will be the pain intensity and functional limitation 10 weeks after randomisation. The analysis will be performed by mixed linear models using the terms of interaction of the treatment group versus time. The study was approved by an Institutional Ethics Committee and was prospectively registered in the Brazilian Registry of Clinical Trials (RBR-3db643c). Results: Due to the impact of COVID-19 isolation on data collection, the study is still in the process of collecting and recruiting participants, with a team of several Doctoral and Masters’ students from UNISUAM and Bachelor students from IFRJ. The analysis of the results will be performed after the end of the collections, as described in the protocol. It is expected that the experimental group presents a reduction in pain intensity and improvement in function in a superior way when compared to the control group. Discussion: Patients with sciatica are not represented in clinical practice guidelines for low back pain. This study has the potential to contribute to a better treatment of these patients, based on the specificities of this subgroup of low back pain.