Sciatica FAQ: Symptoms, Causes, Which Specialist to See, and Is Surgery Necessary?

This article shares the answers to the ten most frequently asked questions in our outpatient clinic. Each question will be answered briefly first. If you need to read the details, please refer to the corresponding articles below.
Reference article for sciatica symptoms and causes: What are the causes of sciatica

1. What are the symptoms of sciatica?

The classic symptom is pain or numbness starting from the lower back, following the path of the nerve, and extending all the way into the buttocks, thighs, calves, and in some cases, to the feet.

In mild cases, it presents as intermittent tingling, numbness, or a burning sensation, which becomes more noticeable after prolonged sitting or standing, is relieved by rest, and generally does not affect daily activities. In more severe cases, the pain and numbness become persistent, making it difficult to stand or sit for long, and worsening when bending over or lifting heavy objects. Some describe it as feeling like a mild electric shock; the numbness and pain may also become more pronounced when crossing the legs. At its worst, it can cause severe pain, leg weakness, and even muscle atrophy, affecting walking.

Actions that increase abdominal pressure, such as coughing or sneezing, can worsen the pain, and lifting the leg may also become impossible. For a complete explanation, please see "How is sciatica diagnosed".

2. Why do people get sciatica?

Most cases are due to compression of the nerve roots that make up the sciatic nerve, most commonly at the L4, L5 nerve roots or the S1 nerve root. The most common cause is a herniated disc, where the protruding disc presses against the nerve root and causes inflammation.

Other possible causes include spinal stenosis caused by spinal degeneration, lumbar spondylolisthesis, and deep gluteal syndrome (where excessively tight or inflamed deep gluteal muscles compress the sciatic nerve). In rare cases, it can also be caused by tumors, fractures, or spinal infections. Lifstyle risk factors include prolonged sitting, being overweight, poor core muscles, chronic poor posture, smoking, the "three highs" (hyperglycemia, hypertension, hyperlipidemia), and repeatedly lifting heavy objects.

3. Is sciatica the same in young people and older adults?

No, it is not.

In younger populations, it is mostly due to acute posterior disc herniation, where the pain is more sudden and severe. In older adults, it is mainly due to degenerative changes such as disc degeneration and lumbar spinal stenosis, where the disease progresses slowly but gradually worsens, often accompanied by numbness and lower limb weakness. Older adults are also at a higher risk of osteoporosis, and if combined with a vertebral compression fracture, this can also cause sciatica.

For details on the differences, please see "Why do young people also get sciatica?".

4. Which specialist should I see for sciatica?

Orthopedics, physical medicine and rehabilitation (physiatry), and traditional Chinese medicine are all common starting points. However, if the pain has been chronic and recurring, and conservative treatment has achieved limited results, you can also seek an assessment from a pain specialist or interventional pain management physician.

No matter which division you visit, the first step is to confirm the location and severity of the compression, which requires a physical examination plus imaging. Bringing your past X-rays or MRIs and treatment records to your appointment can save a lot of time.

5. Under what circumstances should I seek immediate medical attention?

Please seek immediate medical attention in any of the following three situations; do not just wait and observe: fecal or urinary incontinence or difficulty urinating, numbness in the perineum (groin, saddle area), obvious weakness in the lower limbs, or rapid muscle wasting.

If you do not have the symptoms mentioned above, but the radiating pain in your lower back and legs persists for more than a week without improvement, it is also recommended to arrange for an evaluation as soon as possible, rather than relying on painkillers to push through in the long term.

6. Does sciatica definitely require surgery?

In most cases, no. Clinically, conservative treatment is usually tried first, and the patient's reaction is observed for a period. Surgery is only evaluated when conservative treatment is ineffective or when specific red-flag symptoms appear.

Situations where surgery needs to be considered include: pain that continues to worsen or fail to improve after conservative treatment, persistent weakness or sensory abnormalities in the lower limbs, muscle atrophy, or imaging showing significant nerve compression. For the complete criteria for judgment, please see "Does sciatica require surgery?".

7. What are the non-surgical treatments?

They are arranged according to different stages.

Lifestyle adjustments are the foundation: avoid excessive activity during the acute phase, reduce significant bending and heavy lifting, and maintain proper standing, sitting, and sleeping postures. A back brace may be used short-term when pain is prominent, but long-term reliance is not recommended.

Regarding medication, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are commonly used. When neurological symptoms such as aching, numbness, and tingling occur, tricyclic antidepressants or anti-epileptic drugs may be used. In more severe cases, short-term steroid use is also possible. Long-term reliance on medication for chronic pain is not recommended.

Rehabilitation includes hot compresses, electrical therapy, exercise therapy, and posture education. Lumbar traction is used to reduce intervertebral disc pressure, and Si Clinic also features the German Zimmer electromagnetic pulse equipment to stimulate deep muscle groups.

When conservative treatment has limited effects, regenerative injection therapy (such as high-concentration dextrose, autologous platelet-rich plasma PRP, amniotic fluid, or BMAC) and image-guided interventional procedures will be evaluated. The nerve block and water-cooled neuromodulation at Si Clinic are performed by Director Dr. Loo Ping Seong. The nerve block is positioned using the same GE OEC 3D mobile C-arm as C-TAME. Suitability and which method to use will be evaluated by the physician based on imaging and clinical condition. For a complete explanation of the treatment sequence, please see "What are the treatment choices for chronic pain?".

8. What kind of exercise is suitable?

Focus on core muscle strengthening and flexibility training, such as the glute bridge and dead bug exercises, along with aerobic exercises like walking or swimming; yoga and Pilates are also frequently included.

However, please have your physician or therapist confirm the movements and intensity beforehand. Performing the wrong movements during the acute phase will worsen symptoms, which is more troublesome than not exercising at all.

9. What stretches can I do?

The cat-cow stretch and trunk extension are common rehabilitation items, aiming to relax tight muscles and improve muscle balance. Similarly, it is recommended to perform these under the guidance of a physical therapist instead of following videos on your own.

10. How can I get relief daily? Will it recur?

Focus on resting during the acute phase, adjust your sleeping and sitting postures, avoid crossing your legs, avoid maintaining the same position for a long time, and bend your knees instead of your waist when lifting heavy objects. Acupuncture can also be an supportive option after a professional assessment.

Whether it will recur depends mostly on whether the stress factors on the lumbar spine have changed. If posture and heavy lifting habits are not adjusted, even if there is improvement after treatment, the source of stress remains. For the causes of recurrence and subsequent management, please see "Why does sciatica recur?".

If your pain has been recurring for some time, you can first perform a preliminary evaluation via LINE, and bring your imaging data and treatment records to your appointment. Si Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da'an Dist., Taipei City, operating on an appointment-only basis. Phone: (02) 2366-0186.

Author: Dr. Loo Ping Seong

Last updated: July 26, 2026

Disclaimer: This article is for health education purposes only and cannot replace a doctor's diagnosis and treatment advice. The suitability of any treatment should be evaluated and decided by a doctor. If any acute warning signs described in this text appear, please seek medical attention immediately.