Is It Your Back or Your Hip? Understanding Sciatica and Where Leg Pain Actually Comes From

If you have ever felt pain running from your buttock down the back of your thigh getting out of a low car seat, rolling over in bed, climbing stairs, or sitting through a long drive, you know how hard it is to point at where the trouble is.

Most people assume the spine. Often that is right—but whether this is sciatica or hip pain is worth asking properly. Among 273 patients referred to a spine clinic for degenerative lumbar problems, 138—just over half—also had greater trochanteric pain syndrome, a pain source at the side of the hip. And low back, buttock, thigh and groin pain did not reliably separate the two groups.

The good news? Both common causes respond to loading and time more often than most people expect, and neither usually needs a scan to start.

At Rooted Motion Physical Therapy, we believe knowing which structure is generating your pain is what makes a plan worth following. Here is what leg pain from the spine is, what else produces the same map, and how physical therapy helps sort it out.

What Is Sciatica, Exactly?

Sciatica is the everyday word for lumbosacral radicular pain: pain generated when a nerve root near the base of the spine is irritated or compressed, often by a disc bulging into the space it travels through. The pain is felt along the territory that nerve supplies—which is why it reaches the calf or foot while the problem sits in your low back.

Why Does the Pain Show Up Somewhere Else?

Imagine a Doorbell Wired to the Wrong Room

Press the button at the front door and a bell rings at the back of the house. Nothing is wrong with the bell, or the room it rings in. Button and bell are connected by a wire, and the noise happens at the far end of it.

An irritated nerve root behaves the same way. The problem is at the spine, but the signal is reported along that nerve—so the ache, burning or pins and needles turn up in the thigh, calf or foot. Treating only the place that hurts can mean working on the wrong end of the wire.

The key idea: the nerve is irritated where it leaves the spine, but the pain is felt where that nerve reports to. This is why a leg symptom can have a back cause—and why a careful examination matters more than pointing at the sore spot.

Two sources, one overlapping map. Location alone does not settle it.

So How Do You Tell Sciatica or Hip Pain Apart?

Honestly, not by the map alone—and that is the most useful thing in this article.

In that spine-clinic review, patients with hip-side pain and those without it reported low back, buttock, thigh and groin pain at similar rates. Location did not sort them. What separates them is behaviour: what provokes it, what eases it, whether it travels below the knee, whether numbness or weakness comes with it, and how it responds to loading tests.

Nor does any one test settle it. A Cochrane review of the physical examination for nerve-root pain from a disc found the straight-leg-raise test picked up most people who had one—pooled sensitivity 0.92—while being positive in plenty who did not, at a specificity of 0.28. Used alone, the reviewers concluded, most of the examination performs poorly, and most of those studies came from surgical clinics.

A few patterns are worth knowing, though none is diagnostic alone:

• Pain that travels below the knee, especially with numbness, tingling or a heavy feeling in the leg, points more toward a nerve source.

• Pain concentrated on the bony point at the side of the hip, worst lying on that side at night, points more toward the tendons there.

• Both can be present at once, and in that spine-clinic group they very often were.

What Happens If You Just Wait?

Better than most people fear, and less tidily than most people hope.

A primary-care study tracked 609 people with back-related leg pain monthly for a year. Four patterns emerged: 58 percent improving from mild pain, 3 percent improving from severe, 26 percent persistent moderate and 13 percent persistent severe. Roughly six in ten were improving—and four in ten were not.

Those are group patterns, not a forecast, and the study included leg pain of any duration rather than only scan-confirmed nerve compression. Improvement is the most common path, but persistence is common enough that waiting silently for a year is not a plan.

Four one-year paths. Improvement is the most common, and not the only one.

Does Physical Therapy Help?

It helps, and the honest version is more useful than yes.

A review pooled five randomised trials comparing supervised structured exercise against advice to stay active in sciatica. Exercise came out slightly ahead on leg pain in the short term—a small difference the reviewers graded low-quality evidence—and no better on disability. By intermediate and long-term follow-up there was no difference on either.

Two readings of that are wrong. It does not show physical therapy fails: the comparison was advice to stay active, which is itself active treatment rather than doing nothing. And it does not show any one exercise system is superior—none has been. What it supports is that movement with good guidance is what moves the needle.

What About Surgery?

The number most people want is what happens if they do not have it. In a trial of 128 people whose sciatica had already lasted four to twelve months, 64 were assigned to non-operative care. Of those, 22—about a third—went on to surgery, roughly a year later on average. Two thirds did not.

On timing, a 2025 review pooled 29 studies and 23,550 patients and found no significant difference in back pain, disability or one-year reoperation rates whether surgery happened before or after the three, six or twelve month marks. A sensitivity analysis favoured operating within twelve months for leg pain, by roughly one point on a ten-point scale, on evidence the authors rated low quality.

The defensible summary: trying conservative care first does not appear to cost you much, and the decision belongs with you and your surgeon rather than with an article.

When Leg Pain Needs Prompt Attention

Most leg pain is not an emergency. A few presentations are, and a 2026 review in JAMA sets out the features warranting prompt evaluation rather than watchful waiting: numbness in the saddle region, new bladder or bowel changes, progressive weakness in the leg, and pain after significant trauma. Fever, unexplained weight loss or a history of cancer alongside new back pain also warrant a same-day call to your physician.

Everyday Changes That Can Help

None of these needs equipment, and none replaces an assessment:

• Keep moving within a tolerable range rather than resting flat. Prolonged rest generally makes the first week harder.

• If nights are the worst part, try a pillow between your knees and ankles when you lie on your side.

• Note what makes the symptom travel further down the leg and what draws it back toward the spine. That pattern is useful to your therapist.

The Rooted Motion Difference

We provide one-on-one mobile care throughout Richmond, Henrico, Chesterfield and Midlothian. For leg pain, being assessed where the symptoms actually happen changes what we can see:

• An examination of the back, the hip and how you load the leg, not only the spot that hurts.

• A look at the chair, the car seat and the bed the symptoms are actually provoked in.

• A progressive plan built around what your leg tolerates today, not a fixed protocol.

• Straight talk about imaging, injections and surgery, including where evidence is mixed.

• Regular reassessment, so the plan moves as your symptoms move.

• Clear guidance on what warrants a call to your physician.

• Convenient concierge mobile physical therapy delivered where you are.

Because recovery is not just about settling a sore leg—it is about trusting your body on the stairs again.

Ready to Find Out Where It Is Actually Coming From?

If you have been told it is a disc, or told it is your hip, and the plan has not moved you along, an examination is worth more than another few months of guessing. You do not have to navigate it alone.

Schedule a one-on-one evaluation and we will work out which structure is driving your symptoms, then build a plan around the chairs and stairs you actually use.

Ready to move better and live rooted? Contact Rooted Motion Physical Therapy to schedule a one-on-one evaluation and begin a personalized plan built around the chairs and stairs you actually use.

Research Used for This Article

1. van der Windt DA, Simons E, Riphagen II, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database of Systematic Reviews. 2010;(2):CD007431. DOI

2. Tan LA, Benkli B, Tuchman A, et al. High prevalence of greater trochanteric pain syndrome among patients presenting to spine clinic for evaluation of degenerative lumbar pathologies. Journal of Clinical Neuroscience. 2018;53:89-91. DOI

3. Ogollah RO, Konstantinou K, Stynes S, Dunn KM. Determining one-year trajectories of low-back-related leg pain in primary care patients. Arthritis Care & Research. 2018;70(12):1840-1848. DOI

4. Bailey CS, Glennie A, Rasoulinejad P, et al. Early versus delayed microdiscectomy for chronic sciatica lasting 4-12 months secondary to lumbar disc herniation: a secondary analysis of a randomized controlled trial. Global Spine Journal. 2021;13(7):1856-1864. DOI

5. Low WX, Sehmbi A, Shabani F, et al. The effect of symptom duration on the outcomes of lumbar discectomy for radicular pain secondary to lumbar disc herniation: a systematic review and meta-analysis. European Spine Journal. 2025;34(9):3996-4009. DOI

6. Fernandez M, Hartvigsen J, Ferreira ML, et al. Advice to stay active or structured exercise in the management of sciatica: a systematic review and meta-analysis. Spine. 2015;40(18):1457-1466. DOI

7. Cashin AG, Chou R, Weimer MB, McAuley JH. Low back pain: a review. JAMA. 2026;336(2):144-158. DOI

Educational disclaimer: This article is for general education and is not a substitute for an individualized evaluation. Seek prompt medical care for numbness in the saddle region; new bladder or bowel changes; progressive weakness in the leg; or pain after significant trauma. Call your physician the same day if new back pain comes with fever, unexplained weight loss, or a history of cancer.