Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Stories have the power to challenge our assumptions, and occasionally, one comes along that forces a rethink. The Straits Times recently shared the experience of a 26-year-old Singaporean who faced a diagnosis of sciatica. While many still associate this condition with older adults, persistent nerve pain in the lower back and legs is now being reported more frequently in younger people in Singapore. One major reason is that spending long stretches seated and being sedentary increases pressure on the lower back, which might trigger disc problems and nerve irritation in those who rarely move throughout the day.
Over time, these habits can result in symptoms such as pain radiating down the leg, tingling, and numbness that threaten mobility and quality of life. Because such complaints are still widely believed to be linked only to ageing, younger adults often miss the opportunity for early diagnosis and treatment. Recognising these early signs and reconsidering old perceptions is now essential to prevent long-term complications. This shift in understanding sets the stage for discussing why spine disorders are a concern for every age group, not just older adults.
Sciatica — Not Just an "Older Person’s Problem"
Recent observations from clinical practice increasingly show that risk factors for sciatica extend far beyond ageing alone. Conditions such as obesity, prior injury, diabetes, and certain occupational activities all contribute to nerve pain, even in adults who are otherwise young and active. Additionally, lifestyle factors like prolonged sitting and insufficient exercise have become more commonplace and are recognised globally as contributing to early onset back and nerve issues.
Given this complexity, any adult can be affected, and waiting until symptoms become severe might affect treatment efficacy. Thus, it is important for people of all ages to pay close attention to their bodies and to understand that subtle changes could be the earliest warning signs of a developing problem. In the next section, we will look closely at how to recognise the symptoms of sciatica, so prompt action is possible.
What Are the Warning Signs of Sciatica?
With regards to the breadth of risk factors and the fact that sciatica can affect adults of different ages, it becomes essential to know what symptoms truly warrant attention. Sciatica occurs when the sciatic nerve, a major nerve running from the lower back through the hips and down each leg, becomes compressed or irritated by spine problems like a slipped disc or bony growth. As a result, pain often starts in the lower back or buttock and travels down the leg, and might be accompanied by tingling, numbness, or muscle weakness that makes movement or balance more difficult.
Moreover, these symptoms can persist or gradually intensify, especially during prolonged sitting or with certain activities. Most importantly, sudden loss of bladder or bowel control (incontinence) or new numbness in the groin area are emergency signs that require immediate medical assessment. Recognising these red flags early and seeking timely treatment helps prevent lasting nerve injury and supports a stronger recovery across all age groups. With the symptoms in mind, the next step is to consider which treatment options offer pain relief, address the underlying cause, and restore mobility.
Treatment Options for Sciatica
Since many cases of sciatica improve without surgery, treatment options for sciatica typically begins with simple measures and escalates only if symptoms persist or recur. From there, management progresses from guided spinal rehabilitation to targeted injections.
Self Care and Lifestyle Measures
At first, relative rest with gentle activity helps ease irritation of the spinal nerve roots in the lower back, while preserving movement to limit stiffness. Short walks, avoiding long sitting, and a structured home routine with stretching and basic core work can help reduce sciatica pain and support healing. Heat or cold packs ought to be used for brief periods to improve comfort, guided by a doctor’s advice.
Guided Rehabilitation and Medication
As symptoms stabilise, targeted physiotherapy builds core and hip strength, improves spinal posture, and restores safe movement to reduce recurrences of sciatica. When appropriate, doctors might prescribe short courses of nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics, and in selected cases antidepressants or anti-seizure medicines to modulate nerve pain, with monitoring for side effects and interactions. Taken together, these steps improve day to day function while addressing the sources of spinal strain that tend to provoke symptoms.
Image Guided Injections
If significant sciatica pain continues despite good rehabilitation and appropriate medicine, image guided epidural steroid injections or selective nerve root blocks can reduce inflammation around the irritated spinal nerve. In many cases this relief creates a window to intensify physiotherapy and regain mobility. Because benefits might be time limited, injections work best when paired with an active treatment plan that consolidates progress.
Surgery Options for Severe Cases of Sciatica
If symptoms of sciatica persist despite careful use of self-care, rehabilitation, and conservative treatments, the next consideration is surgery to relieve pressure and pain on the spinal nerves and allow recovery of function. The approach is tailored to what is compressing the nerve, aiming to decompress the canal and protect nerve health. Here are four types of surgery that are commonly performed:
- Facetectomy – This type of surgery trims or removes portions of the facet joints when they contribute to spinal nerve compression and narrowing.
- Foraminotomy – This type of surgery widens the nerve exit canal by removing bony overgrowth so the nerve root has more room to leave the spine.
- Laminectomy – This type of surgery removes a small part of the vertebral arch to create more room in the spinal canal when narrowing from spinal stenosis or bony overgrowth compresses the nerves.
- Microdiscectomy – This type of surgery removes the portion of a slipped or herniated lumbar disc pressing on a spinal nerve through a small incision, while preserving normal tissue.
Oxford Spine & Neuro Has Got Your Back
When sensible measures have been tried and symptoms of sciatica persist, the next best thing to do is a specialist review that confirms the diagnosis and connects findings to the pattern outlined in this guide. In a focused consultation, Dr Colum Nolan brings MRI results together with day-to-day limitations like leg pain, numbness, and weakness, then clarifies how nerve root compression or canal narrowing accounts for those issues and what to pursue next. From there, the plan advances with purpose, starting with the least invasive options and opting for surgery only when required to protect spine nerve function and long-term spinal health. To arrange for an imaging review and a personalised sciatica pain management plan with Dr Nolan, please contact Oxford Spine & Neurosurgery Centre today to book an appointment.
Our Spine Specialist in Singapore
Dr Colum Nolan
Senior Consultant Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Dr Colum Nolan is a Senior Consultant Neurosurgeon and the Medical Director of Oxford Spine & Neurosurgery Centre. He undertook specialist neurosurgery training in Ireland and Australia, and later on completed a complex spine surgery fellowship at Addenbrooke’s Hospital in Cambridge, UK.
Dr Column held key leadership roles including Director of the Spine and Spinal Disorders Programme at the National Neuroscience Institute (NNI), as well as the Head of Neurosurgery Service at Sengkang General Hospital.
With his depth of experience, Dr Colum is committed to guiding each patient towards the safest and most effective treatment for their needs.
