Not ALL “Sciatica” is the same

Is your leg pain *actually* sciatica?

Sciatica is one of the most misdiagnosed conditions in clinic. Many people (and even some clinicians) confuse it with other types of referred pain — and because the term “sciatica” is widely known, people often self-diagnose incorrectly.

Among patients with low back pain, approximately 5-10% have confirmed sciatica (Koes et al. 2007)

Common conditions that mimic sciatica

You might have something called "somatic referred pain"

The painful source is generally from joints, discs or ligaments in the lumbar spine, but the pain is perceived elsewhere. Usually dull, vague and hard to pinpoint.

- The SI joints can refer pain to the lower back, buttock, groin, thigh, calf and foot, mimicking sciatic pain (Slipman et al. 2000)

- Pain from lower back (lumbar) joints can be felt in the buttocks, groin, upper thigh, and sometimes lower leg (Yoo & Kim 2024)

Or you may have "myofascial pain"

Similar to somatic referred pain, myofascial pain coming from muscle tissue, such as gluteus minimus, quadratus lumborum, or piriformis, which can refer to the hip or leg.

- gluteus minimus is often referred to as "the sciatica muscle" as it's very good at mimicking sciatic pain!

sciatica vs referred pain diagram

So how can you tell the difference?

Unlike sciatica, referred pain is not "dermatomal", meaning it is not limited to the area supplied by a specific nerve root but can encompass multiple nerve root areas (dermatomes) and spreads to a wider, less defined area. Sciatic pain is more likely to be felt below the knee and often the pain in the leg is worse than the back pain.

skin dermatomes

There is a simple test you can do at home to see if you have sciatica. It's called the slumps test.

How to perform slumps test:

1. Start by sitting on a chair or bed and slouch so your lower back is rounded

2. Draw your chin down to your chest

3. In this position, slowly straighten one leg at a time, then bend up towards you with the leg straightened. Start with the non-painful side, then go to the painful side. The test is positive if you cannot fully straighten the leg.

4. If this reproduces your symptoms, but the symptoms either go away or get better when you bend your head backwards (towards the ceiling), it is more likely you have sciatica.

slumps test for sciatica

I think I may have sciatica, what should I do?

1. Don't panic.

Half of people with sciatica recover within 6 weeks. Most people will experience an improvement with conversative treatment or surgery (NICE CKS).

The severity of your pain, presence of radiological findings, and nerve root tension signs have mostly no bearing on your prognosis (Ashworth, 2011).

2. Avoid what harms you

Sciatica is usually aggravated by bending, sitting, driving or lifting. You should avoid sitting for more than 20 minutes without getting up to avoid further irritation to the spine. It is advisable to 'sprinkle' movement throughout the day to decrease painful muscle spasms (Liebenson 2012).

3. See a professional

Always see a professional to confirm your diagnosis and get the best advice and treatment.

- American practice guidelines recommend a treatment package including spinal manipulation, mobilisation or massage and exercise for managing low back pain with or without sciatica (Zaina et al. 2023).

References:

Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007 Jun 23;334(7607):1313-7. doi: 10.1136/bmj.39223.428495.BE. PMID: 17585160; PMCID: PMC1895638.

Curtis W. Slipman, Howard B. Jackson, Jason S. Lipetz, Kwai T. Chan, David Lenrow, Edward J. Vresilovic,

Sacroiliac joint pain referral zones,

Archives of Physical Medicine and Rehabilitation,

Volume 81, Issue 3,

2000,

Yoo YM, Kim KH. Facet joint disorders: from diagnosis to treatment. Korean J Pain. 2024 Jan 1;37(1):3-12. doi: 10.3344/kjp.23228. Epub 2023 Dec 11. PMID: 38072795; PMCID: PMC10764212.

National Institute for Health and Care Excellence, NICE CKS: Sciatica (Lumbar Radiculopathy) – Prognosis. Available at: https://cks.nice.org.uk/topics/sciatica-lumbar-radiculopathy/background-information/prognosis/

[Accessed 17 October 2025].

Ashworth J, Konstantinou K, Dunn KM. Prognostic factors in non-surgically treated sciatica: a systematic review. BMC Musculoskelet Disord. 2011 Sep 25;12:208. doi: 10.1186/1471-2474-12-208. PMID: 21943339; PMCID: PMC3287121.

Libenson, C., What can I do for Sciatica? 2012. Journal of Bodywork & Movement Therapies (16) 369-371.

Zaina, F., Côté, P., Cancelliere, C., Di Felice, F., Donzelli, S., Rauch, A., Verville, L., Negrini, S. & Nordin, M., 2023. A Systematic Review of Clinical Practice Guidelines for Persons With Non-specific Low Back Pain With and Without Radiculopathy: Identification of Best Evidence for Rehabilitation to Develop the WHO’s Package of Interventions for Rehabilitation. Archives of Physical Medicine and Rehabilitation, 104(11), pp. 1913-1927.