Sciatica
Overview
Sciatica is pain that travels along the path of the sciatic nerve from the lower back through the buttock and down one leg. It is usually caused by compression of a lumbar nerve root by a herniated disc or bone spur.
At DR+, our GPs with specialised training in pain management provide a comprehensive assessment for sciatica to identify the underlying cause and develop a personalised, non-surgical treatment plan.
What is Sciatica?
Sciatica refers to pain caused by irritation or compression of the sciatic nerve, the largest nerve in the body. This nerve starts in the lower back, passes through the buttock, and travels down the back of each leg.
What Causes Sciatica?
Various conditions can lead to irritation, pinching, or compression of the sciatic nerve, including:
- Lumbar Disc Herniation (Most Common)-A herniated lumbar disc is the most common cause of sciatica. When the inner nucleus pulposus of a disc at L4-L5 or L5-S1 protrudes and compresses the adjacent nerve root, it produces sciatic pain. The character of the pain and the pattern of sensory and motor changes in the leg indicate the specific nerve root level involved.
- Lumbar Spinal Stenosis: Spinal stenosis is a narrowing of the spinal canal, typically from age-related degenerative changes including disc height loss, osteophytes, and ligamentum flavum thickening. It causes bilateral leg pain, heaviness, and weakness that worsen with walking and standing (neurogenic claudication) and improve with sitting or lumbar flexion.
- Piriformis Syndrome: Compression of the sciatic nerve by the piriformis muscle in the deep buttock region produces buttock-dominant sciatic pain that is typically worsened by sitting and hip rotation rather than by lumbar provocation tests. Differentiating piriformis syndrome from lumbar disc sciatica prevents unnecessary spinal investigations and procedures.
- Degenerative Spondylolisthesis: A forward slippage of one vertebra over another (spondylolisthesis) at the L4-L5 or L5-S1 level can narrow the spinal canal and compress sciatic nerve roots. It is more common in women over 50 with degenerative disc disease and may co-exist with lumbar stenosis.
- Rare causes: In some cases, sciatica can be caused by non-spinal issues such as tumors, diabetes, or infections. These are less common but can have a significant impact on the sciatic nerve.
Factors that increase the risk of developing sciatica include:
- Have an injury
- Being overweight
- Have diabetes
- Have osteoarthritis
- Smoke
- Have a sedentary lifestyle
What Are the Symptoms of Sciatica?
Symptoms vary depending on the underlying cause and severity. Common presentations include:
Pain
Lower back pain radiating down the leg: The hallmark symptom of sciatica is pain that originates in the lower back and travels down one or both legs.
Pain intensification during certain activities: Activities such as sitting for prolonged periods, coughing, or standing can exacerbate the pain.
Other Symptoms
Numbness or weakness in the leg: Some individuals may experience numbness, tingling, or muscle weakness in the affected leg or foot.
Duration and sudden onset of symptoms: While some people may experience intermittent symptoms, others might have persistent pain. The onset can be sudden or gradual.
Diagnosis of Sciatica
Physical examination
A thorough physical examination, including testing reflexes and muscle strength, can help determine if the sciatic nerve is affected.
Activities to determine nerve irritation
Specific tests, such as walking on toes or heels, rising from a squatting position, or lifting legs while lying down, can help pinpoint the source of the pain and determine the extent of nerve irritation.
What Are the Treatment Options for Sciatica?
Pain Medication
This involves the use of medications such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), opioids, and other specialised medications designed for pain management. The type and dosage are tailored to the individual’s condition and medical history.
Myospan
Minimally invasive treatments aim to effectively relieve common pain conditions by targeting pain sources.
- Coreflex Injections: Typically contain a corticosteroid and are used for inflamed joints or tissues.
- Platelet-Rich Plasma (PRP) injections: Utilise own platelets to promote healing in damaged tissues.
- Intra-Articular Injections: Most commonly used to treat osteoarthritis in the hip or knee, but they can also be given in other joints, including shoulders, wrists, ankles, hands, and fingers.
For chronic pain conditions originating from spinal issues, Neurospan can be performed by our team of pain specialists from Singapore Paincare Center.
When Should You See a Doctor for Sciatica?
Not all cases need immediate medical attention, but some situations do. See a DR+ doctor if your condition:
- Leg pain radiating from the lower back that started or is progressively worsening
- Leg numbness or tingling not explained by a knee or peripheral nerve cause
- Leg weakness developing or worsening
- Sciatica not improving after 4-6 weeks of rest and conservative care
- Sciatica severely impacting sleep, work, or daily activities
- Any sudden onset of bowel or bladder symptoms alongside leg pain
Our Doctors
Our doctors are experienced in assessing conditions that may cause sciatica, including lumbar disc herniation (slipped disc), spinal degeneration, and other musculoskeletal causes of nerve-related leg pain. Through a comprehensive clinical assessment, they help identify the underlying cause of lower back and leg symptoms such as radiating pain, numbness, tingling, or weakness, and guide appropriate treatment or referral when necessary.
All DR+ doctors undergo additional training through the Singapore Paincare Academy, where they develop skills in performing specialised injection procedures that may be used in selected cases of sciatica. These treatments aim to help reduce nerve inflammation, relieve pain, and support improved mobility and function.
Struggling With Persistent Pain?
Consult one of our DR+ today for a detailed consultation & personalised treatment plan.
Frequently Asked Questions
Can a GP Doctor treats sciatica?
Yes. A GP doctor can assess and manage many cases of sciatica, especially in the early stages. During the consultation, the doctor will evaluate symptoms such as lower back pain, pain radiating down the leg, numbness, tingling, or weakness, and determine whether the symptoms are consistent with sciatica or another spinal or musculoskeletal condition.
Treatment may include pain management medications, activity modification, physiotherapy advice, or targeted injection therapies where appropriate. If more complex evaluation or treatment is required, the GP doctor may also refer the patient to a pain specialist, orthopaedic or spine specialist.
Are there specific risk factors that increase the likelihood of developing sciatica?
Yes, factors such as age, obesity, prolonged sitting, diabetes, and physically demanding occupations can increase the risk of developing sciatica.
Can pregnancy lead to sciatica?
Yes, pregnancy can contribute to the development of sciatica. As the uterus expands, it may exert pressure on the sciatic nerve, causing irritation or compression. Hormonal changes during pregnancy can also increase the flexibility of ligaments around the pelvis, potentially exacerbating symptoms associated with sciatica. Discuss any back or leg pain with our doctors.
How can I differentiate between sciatica and other types of back pain?
Sciatica is characterised by pain that radiates from the lower back down one or both legs, often accompanied by numbness or tingling. Other back pains might not have this radiating pattern.
Are there any lifestyle changes I can make to prevent sciatica or reduce its recurrence?
Maintaining a healthy weight, regular exercise, proper posture, and avoiding prolonged sitting can help prevent sciatica or reduce its recurrence.
How long should I wait before seeking medical attention for sciatica symptoms?
If sciatica symptoms persist for more than a week or are severe, it’s advisable to consult a doctor. Immediate medical attention should be sought if there’s sudden, severe pain or if the pain is accompanied by loss of bowel or bladder control.
Are there any complications associated with untreated sciatica?
Untreated chronic sciatica can lead to permanent nerve damage, loss of feeling in the affected leg, and weakness in the muscles of the leg.
Can sciatica be a symptom of a more serious condition?
While sciatica is often due to a herniated disc or bone spur, it can sometimes be a symptom of a more serious condition, such as a tumour pressing on the sciatic nerve.
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(Kindly note that clinic’s last registration is 15 minutes before closing time.)
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#01-54 The Midtown, Singapore 533971
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(Kindly note that clinic’s last registration is 15 minutes before closing time.)
988 Upper Serangoon Rd, Singapore 534733
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(Kindly note that clinic’s last registration is 15 minutes before closing time.)
Singapore 730018
- Mon: 8:00am – 9:00pm
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- Sun & PH: Closed
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Kindly note that clinic’s last registration is 15 minutes before closing time.
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(Last registration timing – Mon: 8:45pm, Tue – Fri: 4:15pm & 8:45pm, Sat: 12:15pm)
Thomson Imperial Court, Singapore 574424
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- Thu: 8:30am – 3:00pm, 6:00pm-9:30pm
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- PH: Closed
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(Kindly note that clinic’s last registration is 15 minutes before closing time.)
- Mon, Wed & Fri: 8:30am – 12:30pm, 1:30pm – 4:30pm, 6:00pm – 9:00pm
- Tue & Thu: 8:30am – 12:30pm, 1:30pm – 4:30pm
- Sat: 8:30am – 12:30pm
- Closed on Sun & PH
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(Kindly note that clinic’s last registration is 15 minutes before closing time.)
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