Spinal manipulative therapy has already been widely investigated in patients with low back pain and has been shown to be effective in chronic patients. Recommendations for the use of manipulative therapy in patients with sciatic pain are based on indirect evidence, relying on studies with chronic low back pain. The benefits and harms of spinal manipulative therapy are not widely studied in patients with sciatic pain.

To systematically review the effects of spinal manipulation therapy (SMT) for patients with acute, subacute, and chronic sciatica for short-, medium-, and long-term pain and disability.

Systematic review of randomized controlled trials using manipulative therapy versus any comparator group. The search was carried out in the databases MEDLINE, EMBASE, PsycINFO, Global Health, CENTRAL, Web of Science, CINAHL, SPORTDiscus, PEDro, and WHO with the descriptors: Low back pain; Sciatica; Manual Therapy and Randomized Controlled Trial. Two reviewers extracted the data and analyzed the risk of bias using the PEDro Scale and the certainty of evidence with the GRADE approach. The primary outcomes were pain and disability.

Sixteen randomized controlled trials were included in this review (n = 1385). Seventeen comparisons were driven from single randomized controlled trials with low and very low certainty of evidence (GRADE). The mean risk of bias for the included studies was 5.9 (SD=1.5), measured on a 0-10 scale. SMT was shown to be more effective than conventional physical therapy for leg pain, with a low certainty evidence and a moderate effect size (MD= -1.78 points; 95% CI -0.44 to 3.11 in 4 weeks) but not for back pain (MD= -2.04 points; 95% CI -5.15 to 1.07 in 4 weeks). There is low certainty evidence that SMT is similar to microdiscectomy for chronic sciatica in the short term (MD= -0.3; 95% CI -0.95 to 0.35), medium-term (MD= -0.2; 95% CI -0.87 to 0.47), and long term (MD= -0.1; 95% CI -0.82 to 0.62).

The certainty of the evidence ranged from low to very low in all comparisons, with small to moderate size effects. There is uncertainty around the effect estimates of SMT for patients with acute, subacute, and chronic sciatica.

Based on this systematic review, there is uncertainty about the efficacy of spinal manipulative therapy (SMT) for patients with acute, subacute, and chronic sciatic pain. Healthcare professionals should carefully evaluate treatment options for patients with sciatic pain. Further research is needed to evaluate the efficacy of manipulative therapy in patients with sciatic pain.