Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA.
Phys Ther. 2010 Dec;90(12):1717-29. doi: 10.2522/ptj.20090260. Epub 2010 Sep 23.
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.
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.
This investigation was a pilot randomized controlled clinical trial.
The settings were spine specialty and physical therapy clinics.
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.
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.
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.
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.
The limitations of this study were a relatively short-term follow-up period and a small sample size.
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.
治疗性选择性神经根阻滞（SNRB）是治疗坐骨神经痛患者的常用方法。SNRB 后患者通常会被转介至物理治疗，但这种干预顺序的有效性尚未得到研究。
本研究初步探讨了 SNRB 联合或不联合随后的物理治疗对腰痛伴坐骨神经痛患者的疗效。
本研究为一项初步的随机对照临床试验。
研究场所为脊柱专科和物理治疗诊所。
44 名参与者（64%为男性；平均年龄 38.5 岁，标准差 11.6 岁），腰痛，临床和影像学表现符合腰椎间盘突出症，计划接受 SNRB。他们被随机分配接受 4 周的物理治疗（SNRB+PT 组）或在注射后不接受物理治疗（SNRB 组）。
所有参与者均至少接受 1 次 SNRB；28 名参与者（64%）接受了多次注射。SNRB+PT 组的参与者平均接受了 6.0 次物理治疗，共持续了 23.9 天。
使用腰痛残疾问卷、数字疼痛评分量表和总体变化评级在基线、8 周和 6 个月时评估结果。
两组的疼痛和残疾程度均随时间显著降低，在任何随访时，两组之间在任何结果上均无差异。在随访期间，有 9 名参与者（SNRB 组 5 名，SNRB+PT 组 4 名）接受了手术。
本研究的局限性在于随访时间相对较短，样本量较小。
SNRB 后进行物理治疗干预并不能进一步减轻腰痛伴坐骨神经痛患者的疼痛和残疾程度，也不能改善其感知。
