Initial Management of Sciatica

Abstract

Since in early times sciatica was attributed to evil spirits, treatments such as chants, rituals and back manipulations were designed to force out the evil spirits. Hippocrates and his followers used moderate therapeutic interventions for sciatica including heat, massage, bed rest, dietary alterations, and soothing music. Later physicians became progressively more aggressive in their therapies. In the seventh century, Paul of Aegina recommended burning the hip joint at three or four places if conservative management failed. In the early tenth century, the famous Persian physician, Rhazes, claimed to successfully treat 1000 cases of sciatica in Baghdad with prolonged bleeding of the lower extremity. Even with the improved understanding of sciatica mechanisms in the nineteenth and early twentieth century, aggressive treatments continued to be popular including counter irritants (brine, wet cupping, and blistering) and a long list of physical agents (hydrotherapy, electrotherapy, ionic therapy, and even x-rays and radium as they became available). Only the rare patient survived treatment of sciatica unscathed.