Recovery of impaired muscle function in severe sciatica

This is a prospective cohort study of patients with acute treated severe sc iatica. The objectives of the study are, firstly, to describe the recovery of muscle performance by manual and isokinetic muscle testing in patients w ith acute severe sciatica over 1 year, and secondly, to discuss the potenti al clinical relevance of the isokinetic testing of the ankle for patients w ith acute sciatica. In clinical daily practice, muscle performance is evalu ated by means of isometric manual tests. Different authors using manual mus cle tests have reported the long-term outcome of the muscle function in pat ients with sciatica. Overall, the results are good in terms of the recovery of muscle strength. However, it is not clear whether the isometric strengt h is sufficiently relevant to evaluate the more complete muscle performance of the affected muscles in patients with sciatica. This study presents dat a on the muscle recovery measured with manual testing and isokinetic testin g of patients with severe sciatica. Consecutive patients admitted to the Ca ntonal Hospital for conservative management of severe acute sciatica were e ligible for inclusion in the study. Patients were evaluated at admission, d ischarge, and follow-up at 3, 6, and 12 months. All the visits included a s tandardized clinical examination and the completion of questionnaires. Imag ing and electromyography were conducted at the first visit. Isokinetic musc le tests at 30 degrees /s and 120 degrees /s were performed at discharge an d follow-up visits. Manual and isokinetic tests were performed on foot and ankle flexor and extensor muscles. Eighty-two consecutive patients (66% men ), with a mean age of 43 (+/- 10.3) years, entered the study. The prevalenc e of major muscle weakness was low, with 7% of patients unable to perform t oe walking and 11% unable to walk on the heel at visit one. Moreover, motor deficit defined as a score of 4 or less (out of 5) was found in 15% of sub jects at the first evaluation. Such severe deficits were not found during t he last three visits. The isokinetic tests showed a higher prevalence of mu scle function impairment. At visit 5, the isokinetic test showed impaired m uscle function recovery from 23% to 32%, while the manual test showed almos t full recovery. The issues of agreement between manual and isokinetic musc le testing are discussed. In this selected and homogeneous cohort of patien ts, the prevalence of motor deficit was rather low and the outcome excellen t according to the results of the manual testing. Isokinetic muscle tests s howed a higher prevalence of deficit and a much slower recovery. The manual muscle test is a crude clinical test. For more indepth muscle performance evaluation, additional testing may be necessary, especially for those patie nts with physically demanding jobs or activities.