Sciatica physiotherapy in Milton Keynes

What this usually is

Sciatica is not a diagnosis in itself — it is leg pain, often with numbness, tingling or weakness, caused by irritation or compression of one of the nerves that runs from the lower back down the leg. It is different from ordinary back pain (see our back pain page), because the nerve itself is involved, and that changes both what we look for in the assessment and, occasionally, what needs to happen next.

The pain usually travels below the knee, sometimes as far as the foot, and often follows a specific strip of the leg rather than spreading generally — which nerve is affected changes exactly where you feel it. It is most often caused by a disc bulge or herniation pressing on or irritating a nerve root, or by narrowing of the space the nerve passes through. As with back pain, a disc finding like this on a scan is common in people with no symptoms at all — a systematic review of imaging in pain-free adults found disc degeneration in around a third of pain-free 20-year-olds, rising with age (Brinjikji et al., American Journal of Neuroradiology, 2015) — so a scan finding on its own does not tell the whole story, and does not usually change what we do first.

According to PubMed: Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. DOI: 10.3174/ajnr.A4173.

That is why imaging is not the first step for most people. In line with the NICE guideline on low back pain and sciatica (NG59), assessment relies first on your history and a hands-on neurological examination, with imaging reserved for cases where it would actually change the plan — most often when symptoms are not settling as expected, or when something in the assessment points to it being needed sooner.

Most sciatica improves without surgery. A review of the evidence on lumbar disc herniation describes a generally favourable natural history, and cautions against considering surgery before a period of around six weeks has passed (Delgado-López et al., Neurocirugía, 2017) — broadly consistent with the staged, conservative-first approach in NICE NG59. Physiotherapy's role is to keep you moving safely while that natural process happens, and to recognise promptly if you are one of the smaller number of people who need more.

According to PubMed: Delgado-López PD, Rodríguez-Salazar A, Martín-Alonso J, Martín-Velasco V. Lumbar disc herniation: natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests. Neurocirugía (Astur). 2017;28(3):124-134. DOI: 10.1016/j.neucir.2016.11.004.

How we treat it here

Assessment first — a full history, and a neurological screen: checking the reflexes, muscle strength and sensation in your legs, alongside the straight leg raise test described above, to work out whether a nerve is involved and, if so, which one. That distinction shapes everything that follows.

For most people, treatment centres on staying appropriately active rather than resting, together with specific exercises and positions that ease the nerve irritation — what helps varies from person to person, which is exactly what the assessment is for. Objective strength and asymmetry measurement gives a baseline you can see, and the on-site rehabilitation gym means loading is progressed under supervision rather than handed over as a generic sheet. The Neubie neuromuscular device may have a role where pain is making it hard to engage the muscles that support the back and leg, used alongside movement and exercise rather than as a stand-alone treatment, in the same way it is used for back pain.

If the picture is unclear, if there is significant or worsening neurological loss, or if symptoms are not settling as expected, a consultant opinion is available on site — including discussion of further imaging, injection or surgical options where genuinely appropriate — without starting again somewhere else.