Sciatica Isn’t Always a Back Problem
5 Non-Spinal Causes of Leg Pain
If you’ve ever been told you have “sciatica,” you were probably also told it’s coming from your lower back. While that can be true, it’s not the whole story.
In reality, not all leg pain labeled as sciatica originates from the spine. At Repsher Physical Therapy, we frequently see patients whose symptoms look like sciatica—but whose backs are not the primary issue at all.
Understanding the difference matters, because treatment should match the source, not just the symptoms.
What Is Sciatica, Really?
Sciatica is not a diagnosis—it’s a description of symptoms.
Typically, it includes:
Pain traveling from the low back or hip into the buttock, thigh, or calf
Burning, aching, or electric-like pain
Tingling or numbness in the leg
The sciatic nerve is the largest nerve in the body, and it travels through multiple regions. That means irritation can occur in more than one place, not just the spine.
5 Non-Spinal Causes of Sciatic-Type Pain
1. Deep Gluteal or Piriformis-Related Nerve Irritation
The sciatic nerve passes underneath (and sometimes through) the deep gluteal muscles. Excess tension, guarding, or altered pelvic mechanics can irritate the nerve here.
Clues this may be the cause:
Pain worsens with sitting or prolonged standing
Minimal or no back pain
Symptoms change with hip position or walking
2. Pelvic Alignment & Load Transfer Issues
The pelvis plays a major role in how forces move through the hips and legs. When pelvic motion or load transfer is off—even subtly—it can increase strain on nearby nerves.
This is common after:
Pregnancy
Lower-extremity injuries
Repetitive sport or work demands
3. Hip Joint or Soft-Tissue Referral
The hip can refer pain into the thigh and even down toward the knee or calf. In some cases, the body perceives this as nerve pain even when the nerve itself is only sensitized—not damaged.
Key signs:
Pain reproduced with specific hip movements
Symptoms change with activity rather than rest
Imaging of the spine is normal
4. Nerve Sensitivity (Without Compression)
Not all nerve pain means the nerve is “pinched.” Sometimes the nervous system becomes over-protective after injury, surgery, or repeated flare-ups.
In these cases:
Imaging often looks “fine”
Symptoms fluctuate day to day
Gentle movement often helps more than rest
5. Scar Tissue or Post-Surgical Changes
Previous surgeries in the hip, pelvis, or lower extremity can alter how nerves glide and tolerate load. Even years later, this can contribute to sciatic-type symptoms.
Why This Matters for Treatment
If leg pain is not primarily coming from the spine, treating it like a disc problem may miss the mark.
Effective treatment often focuses on:
Calming nerve sensitivity first
Improving movement quality and load tolerance
Restoring hip and pelvic control
Gradual, specific strengthening—not aggressive stretching
At Repsher Physical Therapy, we assess how symptoms behave, not just where they hurt. That allows us to tailor treatment to the true driver of pain.
When Should You Get Checked?
If you have leg pain that:
Has not improved with rest or time
Isn’t clearly linked to your back
Keeps recurring despite “doing all the right things”
…it’s worth a deeper look.
The Bottom Line
Sciatica is not one problem with one solution.
Leg pain can originate from the back, the hip, the pelvis, or the nervous system itself—and each requires a different approach.
Getting the diagnosis right is the first step toward lasting relief.
If you’re unsure where your symptoms are coming from, we’re here to help.
