What is the most appropriate initial diagnostic test for a patient suspected of having sciatica?

The most appropriate initial diagnostic test for a patient suspected of having sciatica would be to schedule an MRI of the spine. Sciatica is typically characterized by pain radiating along the path of the sciatic nerve, often due to a herniated disc or spinal stenosis. An MRI is the preferred imaging modality because it provides detailed visualization of soft tissue structures, including nerve roots and intervertebral discs, allowing for the identification of potential causes of nerve compression.

While ordering both a plain radiograph and CT scan may provide some information about the spine, they are not as effective as MRI in assessing soft tissue conditions that may underpin sciatica. Plain radiographs tend to show only bones and may miss nuances of soft tissue abnormalities, and while CT scans can provide more detailed views than X-rays, they still fall short compared to MRI's capability in visualizing the neural foramina and surrounding structures.

Pain management with ibuprofen and muscle relaxants might be a helpful step for symptomatic relief, but it does not contribute to diagnosing the underlying issue. Similarly, while physical therapy can be beneficial in the management of sciatica symptoms, it should follow a proper diagnosis rather than serve as an initial diagnostic step.

Utilizing MRI as the initial diagnostic approach enables