Sciatica vs lower back pain: how to tell the difference

What lower back pain usually feels like

Ordinary lower back pain tends to stay local. It sits across the belt line, sometimes to one side, and often feels like a deep ache, a band of stiffness or a sharp catch when you move in a particular direction. It is usually worse first thing in the morning, after long sitting or after a heavy day, and it eases once you get moving.

The pain generally stays above the buttock crease. You might feel some referral into the glute or the top of the thigh, but it is vague and hard to trace, rather than following a clear line down the leg. There is normally no pins and needles, no numbness and no loss of strength.

What sciatica usually feels like

Sciatica is not a diagnosis in itself. It describes symptoms caused by irritation or compression of the sciatic nerve or the nerve roots that feed it. The hallmark is a symptom that travels. Pain runs from the lower back or buttock down the back or side of the leg, sometimes past the knee, sometimes all the way into the foot.

The quality of the sensation is different too. People describe it as burning, electric, shooting or like a hot wire, rather than the dull ache of a tight back. It can come with pins and needles, numbness in a patch of skin, or a leg that feels heavy or weak. Coughing, sneezing or sitting for long periods often makes it spike.

• Back pain: local, achy, eases with movement, no leg symptoms
• Sciatica: travels down the leg, burning or electric, may include numbness
• Sciatica often has a clear line of symptoms you can trace with a finger
• Both can be present at the same time, which is why assessment matters

Why the difference changes the treatment

With local lower back pain, the priority is usually settling protective muscle guarding, restoring movement through the hips and mid back, and rebuilding tolerance to load so the same pattern does not return. Hands on work, myofascial release and a graded exercise plan do most of the heavy lifting.

With nerve related symptoms, the approach is more cautious and more specific. The aim is to reduce what is irritating the nerve rather than to attack the leg with hard pressure. That often means releasing the muscles around the hip and lumbar spine, careful nerve mobility work, positions and habits that unload the area between sessions, and a slower build back to full activity.

What we do in an assessment

An assessment starts with your history: where the symptoms sit, how far they travel, what sets them off and what settles them. From there we look at how you move, test the strength of specific muscle groups, and use simple neural tests to work out whether the nerve is genuinely involved or whether the leg symptoms are muscular referral.

That distinction is the whole point of the appointment. Once we know which one we are dealing with, treatment and your home plan can be built to match, rather than being general work on a sore back.

When to get it looked at sooner

Most back and sciatic symptoms settle with sensible treatment and movement. A few signs deserve prompt medical attention rather than watching and waiting: progressive weakness in the leg or foot, numbness through the saddle region, or any change in bladder or bowel control. If any of those apply, see a doctor or present to an emergency department rather than booking a myotherapy appointment.

Short of that, the general rule is that pain travelling further down the leg over time is a reason to get assessed sooner rather than later. Symptoms that are moving up the leg toward the back are usually heading the right way.

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