Sciatica (Pinched Nerve in Lower Back) Treatment

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What is Sciatica (Pinched Nerve in Lower Back)?

Sciatica is a condition where you experience pain along the sciatic nerve. The sciatic nerve originates near the base of your lumbar spine (in the lower back) and is the largest nerve in your body. It contributes to both motor and sensory functions for your legs and feet.

Sciatica is often the result of pinched or compressed nerve roots, either due to a herniated intervertebral disc, bone spur growths, or other spinal conditions. It may involve occasional tingling or numbness in your butt and thigh, followed by pain that radiates down one or both legs. In some cases, symptoms may come and go, while others may experience persistent, gradually worsening symptoms.

Prompt treatment of sciatica is important because early intervention can help reduce pain and prevent symptoms from worsening.

Types of Sciatica (Pinched Nerve in Lower Back)

Acute vs Chronic Sciatica

Acute sciatica typically refers to short-term pain caused by sudden irritation of the sciatic nerve or its associated nerves. It may occur due to an injury, trauma, or sudden pressure to the nerve itself. You may experience acute sciatica as anything from a short, sharp pain to periods of numbness, tingling, or other discomfort. In most cases, it is treatable with proper rest, medication, and light physical activity.

Conversely, chronic sciatica is a persistent condition that is characterised by worsening symptoms, such as lingering pain that interferes with your daily activities. Targeted treatments may be necessary to alleviate symptoms and prevent further pressure on the sciatic nerve.

Unilateral vs Bilateral Sciatica

Unilateral sciatica refers to nerve pain that only affects one side of your lower body, while bilateral sciatica refers to pain in both legs. Of the two, unilateral sciatica is the more common form. Both types may require immediate medical attention depending on their severity, but bilateral sciatica carries a higher risk of mobility complications if left untreated.

Common Causes of Sciatica (Pinched Nerve in Lower Back)

One of the most common causes of sciatica is a herniated disc. When an intervertebral disc is damaged due to trauma or gradual degeneration, its soft centre can come free from its hard outer shell, compressing nearby nerves. Bony overgrowths, called bone spurs, may also develop and gradually put pressure on these nerves, contributing to sciatic nerve pain.

Other causes of sciatica may include:

Age-related wear and tear.
Degenerative disc disease is the abnormal degeneration of an intervertebral disc, causing pain when the vertebrae rub against each other. More commonly the disc height collapses resulting in the space for the nerve roots being narrowed.
Osteoarthritis is a degenerative joint disease in which the cartilage lining your joints wears down, causing pain as the bones rub against one another. While this condition more commonly causes midline back pain, it can sometimes mimic sciatica.
Foraminal stenosis occurs when certain areas of the lumbar spine become narrower and compress nearby nerves.
Spondylolisthesis is a condition where a vertebral body slips forwards on top of another vertebral body due to severe disc degeneration or a small break in the pars.
Tumours or growths that compress the sciatic nerve.
Nerve damage due to injury or an underlying condition (such as diabetes).
Certain spinal infections.

Symptoms of Sciatica (Pinched Nerve in Lower Back)

Sciatica may cause symptoms in your lower back, buttocks, and legs. These may include:

Sharp pain or mild aches that may radiate to other areas of your lower back and legs.
Pain when coughing, sneezing, or sitting for long periods.
Numbness or tingling.

If you notice any of the following symptoms, speak to a doctor immediately for prompt medical attention, as it could indicate a more severe condition.

Muscle weakness
Loss of bladder/bowel control
Reduced mobility

Management and Treatment for Sciatica (Pinched Nerve in Lower Back)

Treatment is primarily focused on reducing pain and gradually improving mobility and flexibility. Mild cases are typically managed conservatively, though nonsurgical medical treatment may be necessary in some instances. For chronic sciatica, or cases where conservative treatment is unable to provide symptom relief, surgery may be considered as a final resort.

Conservative Management

Hot and Cold Packs

Apply hot and cold packs to your lower back at regular intervals throughout the day. Alternate between them every 20 minutes to ease pain and swelling while promoting a gradual restoration of function.

Gentle Stretches

Light stretching and exercises may also help improve your lower back’s flexibility and prevent muscle weakness from prolonged inactivity. While bed rest is important, too much of it could lead to growing discomfort in other parts of the body or worsen pain and inflammation. Take things slowly at first and gradually scale up your activity as your condition improves.

Nonsurgical Treatments

Physical Therapy

A physiotherapist will guide you on various exercises to help alleviate sciatica symptoms and prevent your lower back from growing weak. Targeted exercises are recommended to manage symptoms, with gradual increases in exercise duration, intensity, and frequency as your recovery progresses. Part of your regimen may include strengthening exercises while limiting bending or twisting movements. You may perform these exercises at a physiotherapy centre or at home, with a personalised therapy plan developed by your physiotherapist.

One exercise you may attempt at home is called bridging. You need to lie on your back, keeping your knees bent and your feet flat on the floor with a hip-width distance between them. Tighten your abdominal muscles and gently squeeze your glutes, then raise your hips until your whole body forms a straight line. Maintain the position for a few seconds, then slowly lower your hips. Repeat a few times with a short break between intervals.

Medications

Prescription and over-the-counter medications may help with temporary pain relief. Your doctor may prescribe nonsteroidal anti-inflammatory medications (NSAIDs) along with muscle relaxants (if needed) for pain management. However, not all medications are first-line treatments and should be taken only as prescribed.

Spinal Injections

A spinal injection involves directly injecting a medication (usually corticosteroids or steroids) into your lower back close to where the sciatic nerve is located. The medication aims to provide temporary symptom relief by reducing swelling and inflammation at the nerve roots and is typically injected alongside a local anaesthetic for your comfort.

Surgical Treatments

If conservative treatments are unable to provide meaningful symptom relief for your sciatica, your doctor will discuss surgery as a final resort to alleviate your condition. They will highlight your surgical options, their potential risks and side effects, treatment outcomes, and any other relevant information you need to know.

You may need to follow certain practices before your surgery to reduce the risk of complications. For example, you may need to pause taking any prescription blood thinners before surgery.

Discectomy

A discectomy is a surgical procedure that removes a part of a damaged or herniated disc to relieve the pressure on the sciatic nerve. The procedure is carried out under general anaesthesia, and may be performed via one of two methods:

As a minimally invasive procedure, where small incisions are made in your skin to allow surgical tools to access the treatment area and perform the necessary surgical processes.
Open surgery is a procedure in which a larger incision is made to access and operate on the treatment area.

In most cases, fragments or a small section of a damaged disc compressing the nerve are removed, but there may be instances where the entire disc must be removed. In the latter case, a bone graft (taken from your body or a donor’s, or a synthetic source) is inserted into the space where the disc was situated. It will then be fused with the adjoining vertebrae to support your lumbar spine.

Laminectomy

A laminectomy is performed to remove the lamina, the protective bony arch that covers the back of the spinal cord. The procedure aims to relieve pressure on your sciatic nerve and make more room for your spinal cord. This surgical procedure may also be performed as a minimally invasive or open surgery. If necessary, it may be performed alongside a spinal fusion procedure to support your lumbar spine.

Sciatica Nerve Pain Diagnosis

Physical Examination

Your doctor will first assess your condition via a comprehensive physical examination. They will carefully check your lower back for signs of sciatica. They will also review your medical history and ask various questions to understand your current state of health, such as what medications you are taking, the nature of your work, and other relevant queries. The doctor may also conduct tests to assess changes in your gait and posture to inform their diagnosis and treatment plan.

One test they may use is the straight leg test. While lying on an exam table, keep your legs straight and relax as the doctor slowly lifts one leg at specific angles. They will ask whether you experience any pain or discomfort during this movement, which helps the doctor identify the affected nerve(s).

Abnormal reflexes in the knee and ankle combined with weakness of certain muscles in the lower limb may give the doctor an indication that a nerve root may be pinched. Disturbances in sensation can also be due to a certain nerve being compressed.

Imaging Tests

The doctor may order imaging tests to visualise the nerve roots and surrounding structures, allowing them to assess the severity of your condition, refine their diagnosis and treatment plan, and rule out other complications.

X-rays are used to look for signs of trauma or injury to the surrounding bone (such as fractures) or the presence of bone spurs that may be pinching the nerve.
Magnetic resonance imaging (MRI) can create detailed images of the soft and hard structures in your lower back, giving the doctor a clear view of what may be causing your sciatica.
Electromyography (EMG) is used to measure electrical impulses generated by nerves and to assess muscle responses, helping confirm the severity of your condition.

When Should You Seek Treatment for Sciatica?

If you have been experiencing frequent or intermittent pain that resembles sciatica, it may be wise to see a specialist to assess your condition and determine the cause of your pain and other symptoms. They will provide you with key information to help you understand your condition and the treatments needed to support your gradual recovery and reduce symptom severity, whether or not surgery is involved.

Contact Avant Orthopaedic today to learn more about our chronic pain management and treatment processes.

Our Orthopaedic Doctor and Surgeon for Sciatica in Singapore

Dr. Razmi

FAMS (Ortho) | M Med (Gen Surg) (SG) | FRCSEd (Gen Surg) | MBBS (SG)

Dr. Razmi, a practicing orthopaedic and spine consultant at Mount Elizabeth Novena Hospital.

Dr Razmi routinely performs discectomy (minimally invasive surgery), decompression surgery, spinal fusion, motion preservation surgery including dynamic stabilization and dynamic fusion technologies and lumbar and cervical disc replacements. He is the first surgeon in Singapore to perform stand-alone anterior approached spine fusion using the Synfix implant.

Frequently Asked Questions About Sciatica (Pinched Nerve in Lower Back)

Can I prevent sciatica?

There are several preventive measures you can take to help reduce the risk of sciatica. These include:

Quitting smoking or vaping
Exercising regularly every week
Maintaining a good standing and sitting posture
Lift objects with your knees instead of your back
Get sufficient rest
Remove potential fall hazards at home

How long does it take to recover from sciatica?

Recovery time varies from person to person depending on the severity of your condition, how you respond to treatments, and various other factors. After your discharge, you may need to be mindful of your overall mobility and daily activities, as you still have some recovery to complete. It is good to stay active, but always pay attention to your body and your surroundings. Speak to your doctor about how to ease back into your regular activities during your recovery.

Can sciatica occur during pregnancy?

Various factors can lead to sciatica during pregnancy, such as hormonal and foetal changes. It is important to seek medical support to minimise the risk of sciatica and ease your pregnancy journey.

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