title: A pilot study examining the effectiveness of physical therapy as an adjunct to selective nerve root block in the treatment of lumbar radicular pain from disk herniation: a randomized controlled trial.
abstract: BACKGROUND
  Therapeutic selective nerve root blocks (SNRBs) are a common intervention for patients with sciatica. Patients often are referred to physical therapy after SNRBs, although the effectiveness of this intervention sequence has not been investigated.
  
  
  OBJECTIVE
  This study was a preliminary investigation of the effectiveness of SNRBs, with or without subsequent physical therapy, in people with low back pain and sciatica.
  
  
  METHODS
  This investigation was a pilot randomized controlled clinical trial.
  
  
  METHODS
  The settings were spine specialty and physical therapy clinics.
  
  
  METHODS
  Forty-four participants (64% men; mean age=38.5 years, SD=11.6 years) with low back pain, with clinical and imaging findings consistent with lumbar disk herniation, and scheduled to receive SNRBs participated in the study. They were randomly assigned to receive either 4 weeks of physical therapy (SNRB+PT group) or no physical therapy (SNRB alone [SNRB group]) after the injections.
  
  
  METHODS
  All participants received at least 1 SNRB; 28 participants (64%) received multiple injections. Participants in the SNRB+PT group attended an average of 6.0 physical therapy sessions over an average of 23.9 days.
  
  
  METHODS
  Outcomes were assessed at baseline, 8 weeks, and 6 months with the Low Back Pain Disability Questionnaire, a numeric pain rating scale, and the Global Rating of Change.
  
  
  RESULTS
  Significant reductions in pain and disability occurred over time in both groups, with no differences between groups at either follow-up for any outcome. Nine participants (5 in the SNRB group and 4 in the SNRB+PT group) underwent surgery during the follow-up period.
  
  
  CONCLUSIONS
  The limitations of this study were a relatively short-term follow-up period and a small sample size.
  
  
  CONCLUSIONS
  A physical therapy intervention after SNRBs did not result in additional reductions in pain and disability or perceived improvements in participants with low back pain and sciatica.
authors.affiliation: Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA. a.thackeray@utah.edu
authors.forename: Anne
authors.initials: A
authors.lastname: Thackeray
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Brennan
authors.forename: Faisel M
authors.initials: FM
authors.lastname: Zaman
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Willick
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications*; D008159:Lumbar Vertebrae / Q000294:innervation*; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D011843:Radiculopathy / Q000209:etiology / Q000534:rehabilitation*; D012585:Sciatica / Q000209:etiology / Q000534:rehabilitation*; D013126:Spinal Nerve Roots; D018709:Statistics, Nonparametric; D016896:Treatment Outcome