Medically reviewed by Dr Mathew Tung Yu Yee, Spinal Specialist Neurosurgeon
Key takeaways
- Sciatica is not a diagnosis in itself. It describes pain travelling along the sciatic nerve, and the useful question is always what is compressing that nerve.
- The most common cause is a slipped disc in the lower back pressing on a nerve root.
- Most sciatica improves without surgery, typically over a period of weeks.
- Pain that travels below the knee, usually on one side, is the characteristic pattern.
- Loss of bladder or bowel control, numbness around the groin, or weakness in both legs needs emergency assessment on the same day.
Table of Contents
- What is sciatica?
- What causes sciatica?
- Sciatica symptoms
- How sciatica is diagnosed
- Sciatica treatment options
- Sciatica surgery: when it is recommended
- How long does sciatica take to go away?
- What makes sciatica worse?
- Can sciatica be prevented?
- When to see a sciatica doctor in Singapore
- Speak to a spine specialist
- Sciatica FAQ
What is sciatica?
Sciatica is pain that travels along the path of the sciatic nerve — from the lower back or buttock, down the back of the thigh, and often below the knee into the calf or foot. It is a symptom rather than a diagnosis, and it means a nerve is being irritated or compressed somewhere along its course.
This distinction matters more than it might appear. Two patients with identical sciatic pain can have entirely different underlying problems requiring different treatment. Effective treatment depends on identifying which one applies.
The sciatic nerve
The sciatic nerve is the largest nerve in the body. It is formed from nerve roots emerging from the lower spine, and it runs through the buttock, down the back of the thigh, and divides behind the knee into branches supplying the lower leg and foot.
Because it is formed from several nerve roots, the precise pattern of your pain indicates which root is involved. Pain and numbness down the outside of the calf into the top of the foot suggests one level; pain into the sole and little toe suggests another. Your specialist will use that pattern, alongside your reflexes and muscle strength, to locate the problem before any scan is taken.
What causes sciatica?
Most sciatica is caused by pressure on a nerve root in the lower back rather than by a problem with the sciatic nerve itself. Identifying which structure is responsible is the first step in treatment, as the options differ considerably between them.
Slipped disc
The most common cause. When the soft centre of a lumbar disc pushes through its outer wall, it can press on the nerve root beside it. This typically produces leg pain that is worse than the back pain, often worse on sitting, coughing or sneezing.
More on this on our slipped disc treatment page.
Spinal stenosis
Age-related narrowing of the spinal canal or the openings the nerve roots pass through. Stenosis tends to affect an older age group than disc herniation, and produces a characteristic pattern: leg pain and heaviness that comes on with walking and eases with sitting or leaning forward — over a supermarket trolley, for instance.
Spondylolisthesis
Where one vertebra has slipped forward relative to the one below, the openings the nerves pass through can narrow. This can cause sciatica alongside lower back pain, often worse on standing and walking.
Piriformis syndrome
Less commonly, the sciatic nerve is irritated by the piriformis muscle deep in the buttock rather than by anything in the spine. This tends to produce buttock pain that is worse on prolonged sitting, without the back pain typically seen with a disc problem.
We cover this in detail in our guide to piriformis syndrome.
Less common causes
Sciatic symptoms can occasionally result from other conditions, including spinal infection, tumours affecting the spine, or complications of diabetes affecting the nerves. These are uncommon, but they are part of why persistent or unusual sciatica warrants proper assessment rather than indefinite self-management.
Sciatica symptoms
The characteristic symptom is pain travelling from the lower back or buttock down one leg, frequently below the knee. It is usually one-sided, and the leg pain is often more troublesome than any back pain.
Commonly reported symptoms include:
- Pain described as sharp, burning or electric rather than the dull ache of muscular back pain
- Pain that worsens on sitting, and often eases on standing or walking
- Pain that worsens on coughing, sneezing or straining
- Numbness or pins and needles following the same path as the pain
- Weakness in the leg or foot — for example, difficulty lifting the front of the foot, or pushing off when walking
- Symptoms in one leg; sciatica affecting both legs simultaneously is less common and worth mentioning specifically
Warning signs that need urgent assessment
Seek immediate medical attention if you experience:
- Loss of bladder or bowel control, or difficulty passing urine
- Numbness around the groin, buttocks or inner thighs
- Weakness developing in both legs
- Rapidly worsening weakness in one leg
- Sciatica following significant trauma, or accompanied by fever or unexplained weight loss
The first three can indicate cauda equina syndrome, a rare but serious compression of the nerve bundle at the base of the spine. It requires assessment the same day, as delay can result in permanent problems.
How sciatica is diagnosed
Diagnosis is usually clinical. A consultation and physical examination will normally identify both that the problem is nerve-related and which level of the spine is involved. Imaging is used to confirm the cause and is particularly relevant when treatment is not working or surgery is being considered.
Examination
Your specialist will test reflexes, muscle strength and sensation in both legs, comparing sides. Specific tests that stretch the sciatic nerve — raising the straight leg while you lie flat, for example — help confirm nerve irritation and often reproduce your symptoms.
Where pain is worse on walking and eases on sitting, that pattern itself points towards stenosis rather than a disc.
Imaging
An MRI shows discs, nerves and soft tissue and is the investigation of choice where imaging is needed. X-rays show alignment and can identify spondylolisthesis or fractures.
Not everyone with sciatica needs a scan immediately. Where symptoms are typical and improving, imaging often adds little to the initial treatment plan. It becomes important when symptoms persist, when there is weakness, or when a procedure is being planned.
Sciatica treatment options
Most sciatica improves without surgery. Treatment during recovery focuses on settling the nerve irritation, maintaining movement, and addressing whatever is compressing the nerve.
Staying active and modifying activity
Prolonged bed rest is not recommended and tends to slow recovery. The general approach is to keep moving within the limits of comfort, avoid the specific positions that aggravate symptoms — usually prolonged sitting — and return to normal activity progressively. Short walks are often better tolerated than sitting.
Physiotherapy
Physiotherapy is central to treatment. A tailored programme typically includes exercises to reduce nerve irritation, strengthening for the muscles supporting the lower back and pelvis, and guidance on sitting, lifting and movement to reduce recurrence.
Programmes differ by cause. Exercises appropriate for a disc-related problem are not necessarily appropriate for stenosis, which is one reason a generic exercise sheet often disappoints.
Medication
Medication is used to make movement and rehabilitation possible. Options may include anti-inflammatory medication, simple pain relief, short courses of muscle relaxants, and medication specifically for nerve-related pain. Your doctor will advise on what suits your situation.
Nerve root and epidural injections
Where pain remains significant, an injection can deliver anti-inflammatory medication close to the affected nerve root. This can reduce inflammation enough to allow rehabilitation to progress, and is commonly used as a step between conservative treatment and surgery. Injections are performed under imaging guidance for accuracy.
Spinal decompression therapy
Non-surgical decompression uses controlled traction to reduce pressure within the disc. It is used in selected cases; your specialist will advise whether it is appropriate for your particular problem.
Sciatica surgery: when it is recommended
Surgery is considered when non-surgical treatment has not achieved enough after a reasonable period, or earlier where there is significant or progressive weakness. It is directed at relieving the compression causing the leg pain.
The most common procedure is a microdiscectomy, in which the portion of disc pressing on the nerve is removed through a small incision. Where the cause is stenosis rather than a disc, a decompression procedure to create more space around the nerves may be appropriate instead.
Surgery is more likely to be recommended when:
- Leg pain has not settled after an adequate period of non-surgical treatment
- There is muscle weakness, particularly if it is worsening
- Pain is severe enough to prevent work, sleep or normal activity
- There are signs of cauda equina syndrome — in which case surgery is urgent
What surgery does and does not achieve
Decompression surgery is generally more effective for leg pain than for back pain. Patients whose main complaint is leg pain tend to be more satisfied with the result than those whose main complaint is back pain, and your specialist will be clear about which category you fall into before you decide.
Most patients are mobile very soon after a microdiscectomy. Return to desk-based work is usually measured in weeks; physically demanding work takes longer.
How long does sciatica take to go away?
Most sciatica improves over a period of weeks. Symptoms often ease substantially within the first six weeks, and many patients recover fully without any procedure.
Recovery is rarely linear. Good days followed by setbacks are normal and do not usually indicate that anything has gone wrong. What matters more than day-to-day fluctuation is the overall trend over several weeks.
Arrange a review if the pain is not improving after several weeks of treatment, if weakness develops or worsens at any point, or if symptoms return after a period of recovery.
What makes sciatica worse?
Sciatica is typically aggravated by:
- Prolonged sitting, especially in a slouched position or in a low, soft seat
- Long drives without breaks
- Bending forward and lifting, particularly with a rounded back
- Coughing, sneezing and straining, which briefly increase pressure around the nerve
- Sudden increases in activity after a period of rest
- Inactivity, which is as much a problem as overdoing it
Small practical adjustments — a firmer chair, breaking up long periods of sitting, standing to take phone calls, breaking a long drive — often make a noticeable difference during recovery.
Can sciatica be prevented?
The underlying causes of sciatica — a slipped disc, spinal stenosis, degenerative change — cannot always be prevented, but several measures reduce the risk of an episode or of it recurring.
- Maintain a healthy weight. Extra weight increases the load on the lower spine and the discs that can go on to compress the sciatic nerve.
- Stay active, with the general strengthening and flexibility work covered under physiotherapy above.
- Keep good posture and avoid prolonged sitting, particularly slouched or in a low, soft seat — the same adjustments covered above under what makes sciatica worse.
- Lift with your legs rather than your back, and avoid twisting while lifting or carrying.
None of these guarantee sciatica will not occur, but they are reasonable, low-cost habits worth adopting regardless.
When to see a sciatica doctor in Singapore
It is reasonable to seek assessment if leg pain has not improved after two to three weeks, if it is preventing work or sleep, or at any point if you notice numbness or weakness. Sciatica accompanied by the emergency symptoms listed earlier should be assessed the same day.
Assessment establishes what is compressing the nerve, which determines the treatment. Sciatica caused by a disc, by stenosis and by piriformis syndrome are managed differently, and treating the wrong one is the usual reason a course of treatment does not help.
Spinal conditions at Singapore Sports and Orthopaedic Clinic are managed by Dr Mathew Tung Yu Yee, Spinal Specialist Neurosurgeon, and Dr Lim Heng Hing, Senior Consultant Orthopaedic & Spine Surgeon. You can read more about our spine specialists.
Speak to a spine specialist
If leg pain is not settling, or you have numbness or weakness, an assessment will identify what is compressing the nerve and what can be done about it.
To book an appointment:
- Call or WhatsApp: +65 8805 4227
- Book an appointment online
Same-day appointments are available. X-ray and MRI can be arranged in advance of your consultation.
Sciatica FAQ
