A plain-English guide to two very different types of pain
If you’ve ever had back pain that seems to spread into your bum, your thigh, or even all the way down to your foot, you’re not alone. It’s one of the most common things we see in physiotherapy. But here’s something most people don’t know: not all leg pain that comes from your back is the same thing, and the difference actually matters a lot for how it gets treated.
There are two main types. One involves a nerve being squeezed or irritated. The other doesn’t involve a nerve at all, even though the pain can feel surprisingly similar. Let’s walk through both.
When your brain gets the address wrong
Imagine your back sends a pain signal to your brain, but your brain misreads where it came from and puts the pain somewhere else, like your thigh, lower leg, or your bum. That’s essentially what referred pain is. The problem is in your back, but you feel it somewhere it isn’t.
Referred pain from the lower back tends to feel deep and achy, a bit like a bruise or a dull heaviness. It usually sits somewhere in the buttock or the back of the thigh. It doesn’t follow a clear, neat path down the leg, and most of the time it doesn’t travel past the knee.
Most importantly, no nerve is being compressed or damaged. The nerve is completely fine. It’s just your brain getting the location slightly wrong.
This is actually the most common type of leg pain we see in the clinic and far more common than a genuinely trapped nerve, even though that’s what many people assume they have.
When something is actually pressing on a nerve
This one is different. Here, something physical, usually a bulging disc, is pressing on or irritating one of the nerve roots that exits your spine. These nerve roots are the starting points of the nerves that run all the way down your legs. When one gets irritated, you feel it along the entire length of that nerve.
This is what people usually mean when they say ‘sciatica,’ though that word gets used very loosely. A group of international pain specialists actually recommended in 2023 that clinicians stop using it as a catch-all because it causes so much confusion between two very different conditions.
True nerve root pain has a distinctive feel. People usually describe it as sharp, shooting, burning, or electric, like a jolt running down the leg. It tends to travel in a more defined line, often past the knee and into the foot. And it frequently comes with things that referred pain doesn’t produce: tingling, pins and needles, numbness, or weakness in the leg or foot.
A simple way to tell them apart
| Referred Pain | Nerve Root Pain | |
| Feels like | Deep, achy, heavy | Sharp, shooting, electric |
| Where | Buttock, back of thigh | Down the leg, often to foot |
| Path | Vague and spreading | More defined line |
| Tingling / numbness | Rarely | Common |
| Weakness | No | Sometimes |
That said, these two can overlap, and the only reliable way to tell them apart is a proper clinical assessment and not a Google search.
Why does it matter?
Because the treatment is different. Referred pain usually responds really well to hands-on treatment, targeted exercises, and managing load on the back. It tends to settle quite predictably.
Nerve root pain needs a more careful approach. Early on, the focus is on finding positions and movements that take pressure off the nerve and let it calm down. The good news is that most people with nerve root pain do get better with physiotherapy; surgery is rarely needed.
Getting the right diagnosis from the start means your treatment targets the right problem. That’s time saved, and a lot of unnecessary worry avoided.
Bottom line
Most leg pain that comes from your back doesn’t mean a nerve is trapped, it’s usually your brain getting the address wrong. But some of it does involve a nerve, and the two can feel similar enough to confuse even clinicians.
Either way, both are common, both are treatable, and both start with a good assessment. That’s what we’re here for.
References (for clinical use)
Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain. 2009;147(1-3):17-19.
Schmid AB, Tampin B, Baron R, et al. Recommendations for terminology and the identification of neuropathic pain in people with spine-related leg pain. Pain. 2023;164(8):1693-1704.
Robinson JR. Lower extremity pain of lumbar spine origin: differentiating somatic referred and radicular pain. J Manual Manipulative Ther. 2003;11(4):223-234.
Baron R, et al. Neuropathic low back pain in clinical practice. Eur J Pain. 2016;20(6):861-873.