Pain travelling from the back or buttock down the leg — sometimes nerve, often muscle, and worth telling apart.
What it typically feels like
Pain running from the buttock down the back of the leg
Pins and needles or numbness in the leg or foot
Worse on sitting, coughing or sneezing
A deep ache in one buttock that will not release
“Sciatica” is used for almost any pain going down a leg, but there are two
quite different things behind it, and telling them apart matters.
True nerve irritation — the sciatic nerve is compressed or irritated, often
at the spine. Typically pins and needles, numbness, or a sharp electric quality,
and often worse when sitting, coughing or sneezing.
Referred muscular pain — trigger points in the glutes, and particularly in
piriformis deep in the buttock, refer pain down the back of the leg in a pattern
that mimics sciatica convincingly. This one responds very well to soft tissue
work.
A great many people told they have sciatica have the second. Assessment sorts
out which, because treating one as the other wastes everybody’s time.
What treatment involves
For the muscular pattern, treatment is straightforward and often quickly
effective — releasing the glutes and piriformis, settling the trigger points,
restoring hip movement, and addressing why they got tight.
For genuine nerve irritation, treatment is gentler and focuses on reducing the
tension in the surrounding tissue while the nerve settles. It can help, but it
is not a substitute for proper diagnosis.
Read the red flags below carefully on this one. Numbness around the groin,
any loss of bladder or bowel control, or weakness in both legs is a medical
emergency, not something to book a massage for.
What is actually in the lower back
Five large vertebrae carrying the weight of everything above them, with the pelvis beneath and a thick column of muscle either side. It is the most common problem through the clinic door.
Erector spinae
The long muscle columns running either side of the spine. They extend the back and hold you upright, and they are what goes into spasm when a back "locks up".
Quadratus lumborum
Deep, between the lowest rib and the pelvis. Frequently the real source of a one-sided lower back ache that will not settle, and often missed because it sits underneath everything else.
Glutes
Not the back, but they belong in any account of it. When the glutes do not do their share of the work, the lower back does it instead, every time.
Sciatic nerve
The thickest nerve in the body, running from the lower back through the buttock and down the leg. Irritation anywhere along it can send symptoms the whole way down.
Lumbar discs and facet joints
The shock absorber and the guide rails. Both can refer pain into the buttock and thigh without anything being wrong with the buttock or thigh.
Why it goes wrong
Most lower back pain is not damage, and scans in people with no pain at all routinely show changes that sound frightening on a report. Far more often it is a combination of stiffness, muscles doing the wrong share of the work, and a body that has been in one position too long. Pain travelling below the knee, or any change to bladder, bowel or saddle sensation, is a different matter and needs medical assessment.
This page describes what is common, not what you have. The only way
to know is to have it assessed — and your first session includes a
full assessment, so you leave knowing what is actually going on.