What are the evidence-based conservative management strategies for a patient

Conservative management strategies for lumbar radiculopathy (sciatica) include:

• Providing tailored advice and information to support self-management, including education about the condition and encouragement to continue normal activities.
• Offering group exercise programmes (biomechanical, aerobic, mind–body, or combinations) within the NHS, considering patient preferences and capabilities.
• Considering manual therapy (such as spinal manipulation, mobilisation, or soft tissue techniques) only as part of a treatment package that includes exercise, with or without psychological therapy.
• Considering psychological therapies using a cognitive behavioural approach as part of a treatment package including exercise, with or without manual therapy.
• Considering combined physical and psychological programmes incorporating cognitive behavioural approaches for patients with persistent symptoms or significant psychosocial obstacles to recovery.
• Promoting and facilitating return to work or normal daily activities.
• Pharmacological management should avoid gabapentinoids, antiepileptics, oral corticosteroids, benzodiazepines, and opioids due to lack of benefit and potential harm.
• Oral NSAIDs may be considered at the lowest effective dose for the shortest period, with appropriate monitoring and gastroprotection as needed.

Recommended duration before considering surgical options: Conservative management should be trialled for at least 3 months (acute defined as less than 3 months, chronic as 3 months or longer). Surgery, such as spinal decompression, should be considered only if non-surgical treatment has not improved pain or function and radiological findings are consistent with sciatic symptoms.