Understanding Back-Related Leg Pain: More Than Just Sciatica

At BetterMe Physiotherapy, many of our clients come to us with leg pain they believe is simply “sciatica.” While sciatica is a common cause, not all leg pain is the same. Back-related leg pain can arise from several different mechanisms, each requiring a different approach to treatment and management.

In this article, we’ll explain the key categories of back-related leg pain — and why identifying the source is crucial for recovery.

1. Somatic Referred Pain

• What it is: Pain that originates in spinal joints, discs, or ligaments but is felt in the leg.

• How it feels: Usually a dull, aching pain that can spread into the thigh or calf. It’s not typically sharp or shooting, and it doesn’t follow a nerve pathway.

• Key point: The pain is “referred” — the problem is in the back, not the leg itself.

2. Radicular Pain

• What it is: Caused by irritation or compression of a spinal nerve root (often from a disc bulge or herniation).

• How it feels: Sharp, shooting, or electric-like pain following a narrow pathway down the leg — what most people call “sciatica.”

• Key point: Often accompanied by pins-and-needles, tingling, or burning sensations.

3. Radiculopathy

• What it is: When nerve root compression leads to not just pain, but also neurological changes.

• How it feels: Along with leg pain, there may be numbness, weakness, or loss of reflexes in the affected limb.

• Key point: Radiculopathy can impact muscle strength and movement control, not just cause pain.

4. Spinal Stenosis & Neurogenic Claudication

• What it is: Narrowing of the spinal canal (often age-related) that compresses nerves.

• How it feels: Aching, cramping, or tingling in the legs that worsens with standing/walking and improves with sitting or leaning forward.

• Key point: A classic sign is finding relief when leaning on a shopping trolley or bending forward.

5. Cauda Equina Syndrome (Red Flag)

• What it is: A rare but serious condition where the bundle of nerves at the base of the spine (the cauda equina) becomes compressed.

• How it feels: Alongside severe back and leg symptoms, people may notice:

  • Loss of bladder or bowel control,

  • Numbness in the saddle region (around the buttocks/genitals),

  • Sudden and severe leg weakness.

• Key point: This is a medical emergency — if you develop these symptoms, you should seek urgent hospital care immediately.

Why This Matters for You

Not all leg pain is the same — and neither is its treatment. A thorough physiotherapy assessment can help determine whether your pain is:

• From irritated spinal joints,

• Due to a disc or nerve root compression,

• Related to spinal narrowing,

• Or, in rare cases, a red flag condition like cauda equina syndrome.

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At BetterMe Physiotherapy, we take the time to assess your unique presentation and create a tailored plan — whether that includes hands-on treatment, exercise rehabilitation, education, or referral if further investigations are needed.

✅ Takeaway: If you’re experiencing back or leg pain and aren’t sure what’s causing it, don’t wait for it to worsen. Book an appointment with BetterMe Physiotherapy today and let us help you get back to moving confidently and comfortably.

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