The recommendations on what advice to provide were synthesized from national and international evidence-based guidelines [Waddell, 2004; Chou et al, 2007; Koes et al, 2007; Health Education Board for Scotland and Health and Safety Executive, 2008].

Advice to not rest in bed any longer than is necessary

• The advice that people with sciatica should rest in bed no longer than is necessary is based on expert opinion that keeping active can help people with sciatica cope with their pain, may help them return more quickly to full usual activity, and is unlikely to make their sciatica worse. Clinical trials (with methodological weaknesses) have failed to provide evidence that advice to rest in bed is more effective than advice to stay active, or that bed rest is more effective than physiotherapy.

Advice to keep as active as possible and exercise regularly

• The advice that people with sciatica should keep as active as possible and exercise regularly is based on expert opinion, because a randomized controlled trial (RCT) found no evidence of benefit from adding exercise to conventional treatment or adding exercise to massage/manipulation. RCTs found no statistically significant difference between exercise and traction, or between exercise and manipulation. One small RCT found that people who took exercise were more likely to be satisfied than people who received physical therapy without exercise.