Understanding Low-Back Related Leg Pain: What’s Causing It?
Low back pain is one of the most common conditions treated by physical therapists. If you’ve ever felt pain that starts in your lower back and travels down your leg, you’re not alone. This type of discomfort can be frustrating, limiting, and confusing—especially when you’re not sure what’s causing it.
One of the most frequent questions we hear is:
“Is my pain coming from a muscle issue or a nerve issue?”
Understanding the difference is the first step toward getting the right treatment and finding relief.
Two Main Causes of Low-Back Related Leg Pain
Low-back related leg pain typically stems from one of two sources: muscle/joint irritation or nerve compression. Although the symptoms can seem similar, the patterns are different.
1. Muscle and Joint Pain
Muscle or joint-related leg pain occurs when the muscles, joints, or discs in the lower back become irritated or strained. This pain often:
Spreads into the buttock or upper leg
Feels dull, achy, or sore
Changes with movement (bending, sitting, standing, lifting)
Does not follow a clear path down the leg
Does not include numbness or tingling
Common triggers include prolonged sitting, heavy lifting, or sudden increases in activity.
2. Nerve Pain (Radicular Pain or Sciatica)
Nerve pain is caused by irritation or compression of one of the nerves in your lower back—commonly due to a herniated disc or spinal stenosis. This pain typically:
Follows a specific path down the leg
May reach the calf or foot
Feels sharp, burning, electric, or tingling
Can include numbness or weakness
Nerve pain can be more intense and often interferes with daily activities like walking, bending, or standing.
How to Tell the Difference
Use these simple questions as a guide:
1. What does the pain feel like?
Dull, achy, sore → More likely muscle or joint pain
Sharp, burning, tingling → More likely nerve pain
2. Does the pain move around or follow a straight path?
Moves around → Muscle or joint pain
Clear path down the leg → Nerve pain
3. Is there numbness, tingling, or weakness?
Yes → Likely nerve-related
No → Likely muscle or joint-related
What Can You Do to Feel Better?
For Muscle and Joint Pain
Gentle movement
Flexibility and mobility exercises
Strengthening of the core, hips, and glutes
Posture and movement retraining
These help reduce stiffness, improve load tolerance, and restore normal movement.
For Nerve Pain
Nerve gliding exercises
Activity modification
Anti-inflammatory management
In severe cases: injections or surgical consultation
Early intervention speeds recovery, especially when numbness or weakness is present.
Red Flags: When to Seek Immediate Care
Call your healthcare provider right away if your leg pain is accompanied by:
Loss of bladder or bowel control
Severe or rapidly worsening weakness
Numbness in the groin or saddle region
These symptoms may indicate a medical emergency requiring urgent evaluation.
Take Control of Your Low-Back and Leg Pain
Understanding why your pain is happening helps you choose the right treatment—and avoid making the problem worse. Whether your symptoms are muscle-related or nerve-related, the good news is that most cases improve with the right combination of movement, strengthening, and guidance.
If you’re experiencing persistent or worsening back or leg pain, a KAUNO physical therapist can help identify the root cause and create a customized treatment plan to get you moving comfortably again.
Reference
Silva AM, Amundson L, Bittencourt NFN, Hofstetter CP, Sharma A. Low back-related leg pain: A narrative review on the clinical criteria for patient classification and diagnosis. J Orthop Sports Phys Ther. 2023;53(2):1-40. doi:10.2519/jospt.2023.11320.
