What is Sciatica?
Sciatica is a condition characterised by pain along the sciatic nerve path, from the lower back through the hips and buttocks, down to the legs. It’s typically caused by a “pinched nerve” in the spine due to a herniated disc, bone spur, or narrowing of the spine, known as spinal stenosis. This compression results in pain, inflammation, and sometimes numbness in the affected leg.
The symptoms of sciatica can vary, ranging from a mild ache to severe discomfort that intensifies with activities like sitting or standing for long periods. It can significantly impact daily life, affecting mobility and comfort. While the pain can be intense, most cases of sciatica may improve with time and non-surgical treatments. However, severe sciatica, causing significant weakness or changes in bowel or bladder function, may require surgical intervention.
Symptoms of Sciatica Pain
Understanding the symptoms of sciatica is crucial for recognising the condition and seeking timely medical assistance. Sciatica pain can manifest in various forms, from a mild tingling or dull ache to an intense burning sensation. In some cases, the pain can be so severe that it limits mobility.
Typically, sciatica affects only one side of the body, however the pain pattern varies among individuals. Some may experience sharp pain in a specific part of the leg or hip, coupled with numbness in other areas. This pain or numbness often extends to the back of the calf or the sole of the foot. One of the notable symptoms is the weakness of the affected leg, which can affect walking stability and cause the foot to drag.
The onset of sciatica pain can be gradual, but certain actions or times of the day can exacerbate it. Prolonged sitting or standing often worsens the pain. It may also become more intense at night or during activities that trigger pressure on the lower back, such as sneezing, coughing, or laughing – especially if caused by a herniated disc. Additionally, actions like bending backward or walking more than a short distance can aggravate the pain, particularly if the cause is spinal stenosis.
People with sciatica may also experience discomfort when engaging in activities that increase spinal canal pressure, such as straining or holding the breath, like during a bowel movement.
For an in-depth understanding of sciatica, it’s advisable to consult healthcare professionals who can provide personalised guidance and treatment options based on individual cases.
Causes of Sciatica
Sciatica’s origin lies in issues affecting the sciatic nerve, leading to varying levels of pain and discomfort. This nerve stretches from the lower back, through the hips, and into each leg, and its irritation or compression can result from several conditions:
- Slipped or Herniated Disc: In a slipped or herniated disc, the disc in the spine protrudes and compresses the sciatic nerve. This may result in pain in the lower back and legs, which can range from mild to severe. Additionally, it may cause inflammation and sometimes numbness, due to the nerve’s impact on both sensory and motor functions.
- Spinal Stenosis: This condition involves the narrowing of the spinal canal, leading to compression of the sciatic nerve. Symptoms include leg pain and discomfort, with severity ranging from mild to severe, much like a herniated disc. Numbness and inflammation can also occur.
- Piriformis Syndrome: The piriformis muscle in the buttocks spasms, irritating the sciatic nerve. This results in pain predominantly in the back of the legs, similar in intensity to that caused by a herniated disc, along with possible numbness.
- Pelvic Injury or Fracture: Any trauma to the pelvic region may affect the sciatic nerve, leading to symptoms akin to those from a herniated disc, including pain and potential numbness.
- Tumours: When tumours develop in the spine or near the sciatic nerve, they may lead to sciatica-like symptoms, including pain and discomfort. Additionally, if the tumour is malign, it can also contribute to cancer pain in the affected area, necessitating a careful and thorough medical evaluation to address the cancer and resulting nerve pain effectively.
- Spondylolisthesis: In this condition, a spinal bone slips out of place, compressing the nerve roots that form the sciatic nerve. The resulting pain and discomfort can be similar to that experienced with spinal stenosis or a herniated disc.
- Age and Gender Factors: Men in the 30 to 50 age range are more likely to experience sciatica. The reasons for this age and gender-specific prevalence are not entirely clear but may relate to physical activities and lifestyle factors common in this demographic.
In some cases, despite thorough investigation, the exact cause of sciatica may remain elusive. This highlights the importance of comprehensive evaluations by healthcare professionals to determine the most effective treatment strategies for each individual’s situation. Understanding the underlying cause is key to the provision of pain relief and improving the patient’s quality of life. In situations where the cause is not immediately clear, or if symptoms persist and significantly impact daily life, it’s essential to seek medical advice for proper diagnosis and treatment planning.
Sciatica Treatment Options
Sciatica treatment in Singapore encompasses a range of approaches, tailored to the specific cause and severity of the condition.
Conservative Sciatica Pain Treatment
The initial strategy often involves conservative treatments, focusing on managing pain and reducing inflammation. This includes the use of over-the-counter pain relievers such as ibuprofen or acetaminophen. Applying heat or ice to the affected area is also recommended, typically starting with ice for the first 48 to 72 hours, then switching to heat.
Rest is not generally advised; rather, maintaining moderate activity levels is beneficial. Early on, specific back exercises are recommended to strengthen the back and improve flexibility. After a couple of weeks, patients are encouraged to gradually resume their usual activities, while avoiding heavy lifting or twisting movements for the first six weeks.
In Singapore, where access to varied healthcare options is available, physical therapy is a commonly suggested part of the treatment plan for sciatica. This may include exercises to strengthen core muscles and increase spine flexibility, further aiding in pain management and recovery.
Minimally Invasive Sciatica Treatment
When conservative treatments aren’t effective, minimally invasive options are explored. Epidural steroid injections, for instance, are used to reduce swelling and relieve pain around the sciatic nerve. Another option is disc decompression, aimed at alleviating pressure on the nerve. These methods can provide significant relief, especially when standard medications fall short.
Continued pain may lead to a consultation with a pain management specialist, who can offer a broader range of treatment options. These specialists tailor their approaches based on the individual’s specific condition and needs, ensuring a personalised treatment plan.
Surgery for sciatica pain is generally considered a last resort, primarily used when other treatments have not provided sufficient relief and is typically performed to relieve the compression of spinal nerves. Surgical interventions are undertaken with careful consideration, usually after exploring all other less invasive treatment options.
Each of these treatment approaches is decided upon after thorough consultation with healthcare providers, ensuring that the chosen method aligns with the patient’s overall health status and treatment goals. In Singapore, pain management specialists place emphasis on providing patient-centred care, with a focus on effectively managing sciatica pain while maintaining a high standard of patient safety and comfort.
Strategies to Help Prevent Sciatica
Adopting certain lifestyle changes and habits can significantly reduce the risk of developing sciatica, although prevention isn’t always possible:
Regular Exercise: Incorporating exercises that strengthen the back and core muscles is crucial. These exercises support the spine, reducing the likelihood of nerve compression.
Good Posture and Stretching: Maintaining proper posture, particularly during prolonged sitting, and regular stretching can help alleviate and distribute the pressure on the spine evenly.
Maintaining a Healthy Weight: Excess weight can increase stress on the spine. Keeping a healthy weight helps in reducing this stress, potentially lowering the risk of sciatica.
Healthy Lifestyle Choices: Ensuring sufficient sleep, staying hydrated, and avoiding harmful habits like smoking are essential for spine health. These factors collectively contribute to overall well-being and reduce the risk of spinal issues.
Low-Impact Activities: Engaging in low-impact exercises such as swimming, walking, yoga, or tai chi can keep the spine flexible and strong without exerting excessive pressure.
These preventive measures are not a guarantee but can play a significant role in maintaining spinal health and potentially reducing the risk of developing sciatica.
Seek Help to Relieve Sciatica Pain
When it comes to the management of sciatica pain, there is a need for a comprehensive and patient-centric approach. As such, pain management specialists such as those from The Pain Clinic will begin with in-depth assessments to understand an individual’s pain pattern and health to form the basis of a personalised treatment plan.
This plan includes various treatment methods in line with Singapore’s medical standards, with an emphasis on enhancing one’s quality of life. These treatments are selected to match each patient’s unique needs, ensuring targeted pain relief.
However, it should be noted that such treatments are never a one-size-fits-all solution. The response and tolerance to pain treatments vary from person to person, therefore periodic reviews and modifications of the treatment plan and care for the patient are necessary for better results.
Our clinic is under the following insurance panels
We work with various insurance partners to assist with your hospitalisation and surgery claims. In some instances, pre-approval from your insurer allows direct billing between the hospital and insurer so that you will have peace of mind during your treatment. We are accredited by Singapore’s Ministry of Health (MOH), so you may also utilise Medisave for your hospitalisation expenses.
Meet Our Doctor
Dr Ho Kok Yuen is a specialist in pain medicine and anaesthesia. He completed his pain management fellowship at Duke University Hospital in USA in 2006. He is involved in teaching, research and also serves on numerous advisory boards. Besides writing articles in peer-reviewed journals, clinical practice and consensus guidelines, as well as book chapters on pain and anaesthesia, he lectures at international conferences and teaches at interventional pain workshops frequently.
Dr Ho Kok Yuen obtained his MBBS and Master of Medicine (Anaesthesiology) from the National University of Singapore. He holds a Graduate Diploma in Sports Medicine (GDSM) from the Lee Kong Chian School of Medicine (LKCMed) at Nanyang Technological University.
- Diplomate, American Academy of Pain Management (DAAPM)
- European Diploma in Pain Medicine (EDPM), European Society of Regional Anaesthesia (ESRA)
- European Diploma in Pain Medicine (EDPM), European Pain Federation EFIC
- Graduate Diploma in Sports Medicine, Lee Kong Chian School of Medicine (LKCMed)
- Chairman, Chapter of Pain Medicine Physicians, Academy of Medicine, Singapore
- Council Member, College of Anaesthesiologists, Academy of Medicine, Singapore
- Chairman, South-East Asian Section, World Institute of Pain (WIP)
- Fellow, Interventional Pain Practice (FIPP) with the WIP
- Examiner, FIPP Examinations
- Fellow, Academy of Medicine, Singapore (FAMS)
- Past President, The Pain Association of Singapore (2011-2017)
- Past Vice-President, Association for South-East Asian Pain Societies (ASEAPS) (2012-2013)
Dr Ho Kok Yuen is widely recognised as an expert in minimally invasive interventional pain management, having performed thousands of such surgeries. He treats persistent and severe pain using therapies such as steroid injections, nerve blocks, radiofrequency ablation, intrathecal drug delivery and spinal cord stimulation.
The first physician in Asia to perform cooled radiofrequency ablation, he has been treating spine, sacroiliac joint, hip, and knee pain using this technique since 2006. He also administers spinal infusions to ensure pain-free end-of-life comfort care for patients with advanced terminal cancer pain.
When Boston Scientific launched its most advanced SCS system – the WaveWriter Alpha™ – in Southeast Asia, Dr Ho Kok Yuen was the first doctor to perform the implant surgery. SCS uses electrical impulses to block pain signals in the spinal cord, effectively treating intractable back pain, leg pain and neuropathic pain. SCS therapy has helped hundreds and thousands of people around the world improve their quality of life.
Frequently Asked Questions about Sciatica Pain
For sciatica pain relief during sleep, adopting a foetal position with a pillow between your knees is recommended. This position will help “open up” the spinal canal. Alternatively, lying on your back with a pillow under your knees may also potentially reduce pressure on the sciatic nerve, offering much needed relief.
Common triggers of painful sciatica flare-ups include prolonged sitting, poor sitting or standing posture, heavy lifting, and sudden movements. Stress may also be a contributing factor, as are lifestyle aspects such as being overweight or frequently wearing high heels. Therefore, it is crucial to make relevant lifestyle and posture adjustments that can help prevent future flare-ups.
Relief from sciatica pain often combines physical therapy, over-the-counter pain relievers, and the application of hot or cold compresses. Regular physical activity and targeted exercises to strengthen the back and core muscles are crucial for ongoing pain management and prevention. Always consult a qualified medical professional for personalised treatment options.
To manage sciatic nerve pain non-surgically, a combination of regular exercise, physical therapy, heat or cold therapy, and over-the-counter pain medication may be helpful. It’s also important to avoid activities that worsen the pain and to maintain good posture. Consult a pain management specialist for personalised recommendations of non-surgical treatment options. It is also important to note that in some cases, surgery may be necessary for long-term relief from sciatica pain.