Summary of Background Data. Sciatica as a result of a herniated disk is a fairly common problem; studies have shown a life time prevalence of 4-5 % in the Scandinavian population. Though a herniated disk is a benign disease with a relatively good prognosis, the pain and functional loss, are in most patients rather considerable over a period of some months Reviews have demonstrated no or little efficacy for passive conservative treatment modalities. Results for surgery are conflicting. Cohort studies have shown a high efficacy for active treatment modalities in patients with sciatica.

The current trend in back treatment is information and advice to stay active including active treatment modalities in which patients are given responsibility during the treatment process and the treatment assumes the role of a “coach”.

Objectives. To evaluate the efficacy of two active conservative treatment programs for patients with severe sciatica.

Methods A prospective clinical controlled randomized trial including 181 consecutive patients with radicular pain below the knee. The patients were examined at baseline, 8 weeks later at post treatment follow-up, and, and MR-scanned at baseline and at the one year follow-up The treatment consisted of four elements; 1-3 were identical in both groups. 1. Thorough information concerning anatomy, pathogenesis, how discs heal without surgery, and encouragement to stay as active as possible but to reduce activity if an increase in leg pain occurs. 2. Tender love and care. 3. Medication, this was optional and only weak analgesic and NSAID’S were recommended.

Element 4 was divided into a “Hands on” and “Hands off”, utilizing two different exercise programs. “Hands on” consisted of a variety of back related exercises and optional manual treatment. The exercises were given after a strict algorithm, where different symptoms or a response to exercises determined the exercises given.

“Hands off” exercises were optional and generally not back related. They were geared towards increasing general blood circulation and maintaining strength in the extremities.

Results Both groups experienced a dramatic improvement in functional status, self-perceived pain and as regards clinical findings all outcome measures had improved significantly p<0.0001. The “Hands on” group was significantly superior to the “Hands off” group in nine of the outcome measures, borderline in one and no difference was found in 10 outcome measures. The Hands off was significantly better that Hands on with regards to improvement in Sence of Coherence.

Conclusion Active conservative treatment is efficacious for patients with severe sciatica. These patients had symptoms and clinical findings which would qualify them for surgery in most hospitals.

Inclusion Criteria:

• Radicular pain of dermatonal nature in one or both legs or below the knee Leg pain > 3 on the eleven point box scale20 Radiating pain duration between two weeks and one year Age between 18 to 65 years

Exclusion Criteria:

- Cauda equine syndrome Not having Danish as first language Pending workers litigation claims Inability to follow the rehabilitation protocol, due to concomitant disease Previous back surgery Spinal tumors Pregnancy