Although similar in their drug-free, nonsurgical approaches to care, chiropractic and physical therapy have distinguishing differences. Both approaches have unique benefits and some limitations. Chiropractic focuses more on joint manipulation and physical therapy focuses more on muscles. Sciatica involves inflammation of the sciatic nerve and can be caused by either joint or muscle problems.
Physical therapy or PT is available in both hospital and clinical settings. Although state regulations vary, many states require you to see your doctor to get a referral to see a physical therapist. Even after your doctor does your initial examination and makes the referral, the physical therapist will do an additional evaluation to develop a treatment plan. Initial pain management treatment for sciatica in a PT setting include deep tissue massage, hot and cold therapies, TENS,or transcutaneous nerve stimulation, and ultrasound. Later stages of treatment include exercises for aerobic capacity, strengthening, flexibility and increased range of motion.
The unique contribution made by chiropractic is a focus on joint manipulation, also called an chiropractic adjustment. Chiropractors are considered primary care providers and are seen without a referral from your doctor. After an initial case history and physical examination, which frequently includes X-ray or MRI studies, a treatment plan is developed. Chiropractors seek to reduce joint restriction by making adjustments to the joints by delivering an adjustive thrust to unlock restriction. Improved joint motion reduces inflammation and improves range of motion.
Research directly comparing physical therapy and chiropractic in the treatment of sciatica is scarce. In a 1998 study published in the "New England Journal of Medicine," researchers at the University of Washington found both approaches showed benefit in initial pain management. However, they found that long-term results at the one year mark were only slightly better than a group who received only education about self management.
Both physical therapy and chiropractic have shown benefit in initial pain management and have value in the treatment of sciatica. You may not have to choose as most chiropractors include some physical therapy in their treatment plans and many physical therapists do some joint mobilization. Most trials have looked for long-term changes after only relatively short-term treatment of one or two months. Longer periods of treatment or learning to self manage may produce longer control.