Is it Lower Back Pain or Sciatica? How to Tell the Difference

Written by Julian Newhill, Registered Osteopath (M.Ost, B.A.(Hons), Dip S.M. Julian has 14 years of clinical experience specialising in spinal musculoskeletal conditions. Read his full profile. 

A practical guide from your local osteopaths on identifying your pain and knowing when to seek help.

When your back "goes," it can be incredibly worrying. The stiffness, the sudden twinges, and the aching can make even simple tasks like putting on your socks feel impossible. But one of the most common questions we get asked at Newhill Osteopathy is: "Is this just a bad back, or do I have sciatica?"
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Telling the difference is crucial because the underlying causes—and the best ways to treat them—are quite different. If you are struggling with discomfort and aren't sure what you're dealing with, here is our straightforward guide to help you understand your symptoms.

What is 'Normal' Lower Back Pain?
When we talk about standard lower back pain (clinically known as mechanical or axial back pain), we are usually referring to a problem with the moving parts of your spine. This includes the muscles, ligaments, facet joints, or the outer layers of the spinal discs.

What it feels like:

• A dull, heavy ache across the lower back.
• Sharp spasms or "catching" pains when you move in a certain way (like twisting or bending forward).
• Stiffness, particularly first thing in the morning or after sitting for a long time.
• The pain is generally confined to the back itself. It might radiate slightly into your upper buttocks, but it rarely travels past the crease of your buttocks.

Common causes: Lifting something awkwardly, poor posture at your desk, a sudden unaccustomed movement in the garden, or simply the general wear and tear of daily life.

What is Sciatica?
Sciatica is not actually a condition itself; it is a symptom of a compressed or irritated nerve.
The sciatic nerve is the longest and thickest nerve in the body. It starts in your lower back, runs through your pelvis and buttocks, and travels all the way down the back of each leg to your feet. When something in your lower back (like a bulging disc or a tight muscle) presses on or inflames the root of this nerve, you feel the pain along the nerve's pathway.

What it feels like:

• A sharp, shooting, or burning pain that travels down the back of your thigh and often into your calf or foot.
• The leg pain is usually much worse than the back pain (in fact, you might not have any back pain at all!).
• Neurological symptoms like tingling ("pins and needles"), numbness, or a feeling of water running down your leg.
• Weakness in your leg or foot, making it difficult to stand on your toes or heel.

The 'At-Home' Checklist: Which Do I Have?
If you are trying to figure out what is going on, ask yourself these three questions:

1. Where is the worst pain?

• Mostly in the lower back/waistline? Likely mechanical back pain.
• Shooting down one leg below the knee? Highly likely to be sciatica.

2. What type of pain is it?

• Aching, stiff, or a sudden muscular spasm? Points to back pain.
• Electric shocks, burning, or tingling? Points to nerve irritation (sciatica).

3. What makes it worse?

• Mechanical back pain is often irritated by specific movements (like arching backwards) but eases when you find a comfortable resting position.
• Sciatica is famously aggravated by sitting for long periods, coughing, sneezing, or trying to put your shoes on.

⚠️ When to Seek Urgent Help
As osteopaths, patient safety is our top priority. While both back pain and sciatica can be intensely painful, they are rarely dangerous. However, if you experience any of the following "red flag" symptoms alongside your back or leg pain, you must visit A&E or call 111 immediately:

• Loss of feeling or numbness between your inner thighs or genitals (the "saddle" area).
• Recent onset of bladder or bowel incontinence, or not knowing when you need to go to the toilet.
• Sudden, severe weakness in both legs.

Frequently Asked Questions (FAQ)

Can lower back pain turn into sciatica?
Yes, it can. If a problem in your lower back (such as a disc injury) gradually worsens, the swelling or structural change can eventually start to irritate the nearby sciatic nerve, causing leg symptoms to develop after the initial back pain.

Should I use ice or heat?
For acute, sudden lower back pain or fresh sciatica, wrapping an ice pack in a tea towel and applying it to the lower back for 10-15 minutes can help reduce inflammation. Heat is generally better for chronic, stiff, and aching muscles. Never apply heat or ice directly to the skin.

Can an osteopath help with both?
​Absolutely. Whether you have mechanical lower back pain or sciatica, an osteopath can carefully assess your spine to find the root cause. We use gentle manual therapy, massage, and joint articulation to relieve muscle tension, improve spinal mobility, and take the pressure off irritated nerves.

Get Expert Help in Horley. You do not have to put up with pain, nor do you have to rely on guesswork. If you are struggling with your mobility or are unsure what is causing your discomfort, a proper clinical assessment is the fastest route to recovery.

Contact the friendly team at Newhill Osteopathy today to book your consultation and let’s get you moving comfortably again.

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About the Author
Julian Newhill, Practice Owner. Masters of Osteopathy, B.A. Hons, Diploma Sports Massage

Julian Newhill is a highly experienced osteopath with clinics in Horley and London. He specialises in treating back pain, neck pain, headaches, and migraines, offering effective relief through osteopathy, sports massage therapy, acupuncture, and ultrasound therapy.
With a Master's degree in Osteopathy from the British School of Osteopathy and registration with the General Osteopathic Council (GOC) and Institute of Osteopathy (IO), Julian's expertise is backed by extensive training and experience. He previously worked at the British School of Osteopathy and a private orthopaedic hospital, further solidifying his knowledge in treating a wide range of conditions.
Julian's patient-centred approach ensures personalised care, addressing each individual's unique needs. He's passionate about helping people achieve optimal health and well-being, utilising a combination of evidence-based techniques.
Sports massage therapy aids in injury recovery and enhances performance.
Acupuncture provides natural pain relief, improves circulation, and reduces stress.
Ultrasound therapy promotes healing and reduces pain, particularly for muscle and ligament injuries.

If you're looking for a dedicated and skilled practitioner in Horley, Julian Newhill is here to help you achieve your health goals. Contact him today to schedule an appointment and experience the benefits of his comprehensive approach to healthcare.

**Specialising in:** Manual therapy, acupuncture, osteoarthritis, sports injuries, work related injuries, posture correction and advice.