If your legs ache and you have landed here trying to work out whether it is sciatica, you are in the right place. By the end of this you should have a reasonable idea, and more importantly, you should know whether this is something to manage at home, something to get assessed, or something to get checked today.
Here is the short version before we go through it properly.
Sciatica usually affects one leg. It follows a path down the leg rather than sitting in one spot, it often travels below the knee, and it tends to come with nerve sensations such as pins and needles, numbness or weakness. General aching legs are more often felt in both, are spread out rather than tracking a line, and come without those nerve symptoms.
That is the headline. But plenty of things that are not sciatica cause pain in one leg, and a few of them need a doctor rather than a physiotherapist. So work through the questions below rather than stopping at the summary.
Before we start, one thing about how to use this.
These are the questions a physiotherapist works through in the first few minutes of an assessment. They are not a way to diagnose yourself, and I would not want you to treat them as one. What they will do is help you describe your problem properly, which makes a genuine difference to the quality of any appointment you end up booking. Most people arrive saying “my leg hurts”. Arriving able to answer these five turns a vague conversation into a useful one.
Have a think about each before you read the interpretation.
1. One leg, or both?
Start here, because this question narrows things down faster than anything else.
Sciatica is almost always one leg. The nerve runs down each side separately, and it is unusual for both to be irritated at once.
If both legs ache together, sciatica becomes much less likely. You are more probably looking at something muscular, something circulatory, or occasionally narrowing in the spinal canal, which can affect both sides.
2. Does the pain go below your knee?
This one is more useful than it sounds.
Pain that travels below the knee is much more suggestive of genuine nerve root irritation. Aching that stops at the buttock or thigh is more often muscular, or referred from the lower back without the nerve itself being involved.
So: does it reach your calf, your ankle, your foot? Or does it fade out around the thigh?
3. What does it actually feel like?
Try to answer this with the word you would have used before you read anything about sciatica.
Nerve pain tends to get described as sharp, shooting, burning, or like an electric shock. People often trace it with a finger, because it follows a line.
Muscle pain tends to get described as dull, heavy, cramping, tight or achy. People usually gesture at an area with a whole hand rather than tracing a line.
That difference in how someone points at their own pain is oddly reliable.
4. What makes it worse?
Sciatica typically flares with sitting, with bending forwards, and first thing in the morning. Coughing or sneezing sometimes sends a jolt down the leg, which is a fairly strong pointer towards a disc irritating the nerve.
Muscular aching usually builds after activity and settles with rest.
Circulation-related pain has its own distinct pattern, and it is worth its own section further down.
5. Any pins and needles, numbness or weakness?
This one comes closest to being a decider.
Nerve symptoms mean nerves are involved. If you have tingling in your foot, a patch of numbness, or a leg that feels like it is not doing what you ask, that is nerve territory rather than tired muscles.
Their absence does not rule sciatica out entirely. But their presence makes simple muscle ache an unlikely explanation.
So what do your answers mean?
If you mostly answered the first option, nerve involvement is likely and it is worth reading our guide to sciatica symptoms and treatment next.
If you mostly answered the second, you are probably looking at something in the next section.
And if your answers are a mixture, that is extremely common and it is exactly the situation an assessment is for.
Worth clearing up, because it changes how you read everything else.
Sciatica is a symptom, not a diagnosis. It describes pain travelling along the sciatic nerve. It does not tell you what is causing that pain, and the cause is the part that determines what helps.
The nerve might be irritated by a bulging disc, by narrowing in the spinal canal, or by tightness in the muscles it passes through. Those are three quite different problems with three quite different treatment approaches, all wearing the same label.
This is why two people who both say they have sciatica can be given completely different advice, and why “I have sciatica” tells a clinician far less than most people assume. It is also why the answer to “what should I do about my sciatica” always starts with working out what is behind it. Our back pain and sciatica assessment page explains what that assessment involves.
If sciatica does not fit, here is what else is worth considering. Some of these are entirely benign and some need a GP, so read to the end of the list.
Muscular fatigue and overuse. Easily the most common cause. Aching after more standing or walking than usual, in both legs, easing over a day or two. Unremarkable and self-limiting.
Venous problems, including varicose veins. Heaviness and aching that builds through the day and is at its worst by the evening. Usually improves with the legs elevated. Often both legs, though not always.
Peripheral arterial disease. Cramping in the calves that comes on after a fairly predictable walking distance and eases within a few minutes of stopping. This one needs a GP appointment rather than physiotherapy.
Restless legs syndrome. More of an urge to move the legs than actual pain, worse in the evening and at rest, temporarily relieved by moving. Distinctive once you know the pattern.
Peripheral neuropathy. Burning, tingling or numbness, usually in both feet and working upwards. Frequently linked to diabetes. Worth a medical review.
Spinal stenosis. Aching and heaviness in both legs that comes on with walking and eases when you sit down. More common with age.
Medication. Statins are the most familiar example of a drug that can cause muscle aching. Worth raising with your GP, and worth saying clearly: do not stop taking a prescribed medication on the strength of a blog post.
This is the most useful thing on this page, and almost nobody mentions it.
Nerve-related and circulation-related leg pain behave in opposite ways when you walk. You can observe the difference yourself over a few days, and it tells you a great deal.
If it is spinal stenosis, walking gradually brings the ache on, and what relieves it is sitting down or leaning forwards. A lot of people notice they can walk around a supermarket pushing a trolley for far longer than they can walk down the street, because leaning forward over the handle opens up the space around the nerves. If that sounds familiar, it is a meaningful clue.
If it is arterial, walking brings the pain on at a fairly consistent distance, and simply standing still relieves it within a few minutes. Leaning forwards makes no difference whatsoever. Walking uphill or hurrying brings it on sooner.
If it is muscular, there is no reliable trigger distance. The ache builds with how much you have done overall and eases over hours rather than minutes.
So next time it happens, pay attention to what actually made it stop. Sitting down, standing still, or just time. That single observation is worth more than an hour of searching.
Please read this section even if you skim the rest.
Get urgent medical attention if you have:
Book a GP appointment rather than physiotherapy if you have:
None of these mean something terrible is happening. They mean the answer is not physiotherapy, and a physiotherapist worth seeing will tell you exactly the same thing at a first appointment.
Once you know roughly which category you are in, the path forward gets much clearer.
If it looks like nerve pain, the priority is calming the irritation rather than stretching into it. Gentle movement usually helps more than rest, and prolonged sitting usually makes things worse. There is more detail on our sciatica treatment page, including how long it typically takes to settle.
If it is coming from your lower back, the approach is similar but broader. Our back pain page covers what tends to help and what tends not to.
If it is muscular, ordinary sensible things work. Vary your position, build up activity gradually rather than in bursts, and give it a week or two before assuming it is something more.
If it is circulatory, none of the above applies and a GP is the right next step.
The reason assessment matters so much here is that the treatments genuinely conflict. What helps a tight muscle can aggravate an irritated nerve. Getting the category right first is not a formality.
Quick answers on sciatica, aching legs and when to get leg pain checked.
Look for pain in one leg that follows a path, travels below the knee, feels sharp or burning rather than dull, and comes with pins and needles, numbness or weakness. Pain in both legs, spread out and without nerve symptoms, is more likely something else.
It can, but it is uncommon. Because bilateral symptoms can occasionally signal more significant nerve compression, aching in both legs with numbness or weakness is worth getting assessed sooner rather than later.
Several possibilities. Sciatica often worsens at night because lying still removes distraction and certain positions load the nerve. Restless legs syndrome is worse at rest in the evening. Venous problems tend to have built up across the day. The pattern usually points to the cause.
Usually not, but occasionally. One swollen, warm, painful calf needs urgent attention. So does leg weakness with any change in bladder or bowel control. Cramping calf pain on walking needs a GP.
It depends which it is, which is rather the point of this article. Muscular aching generally responds well to gentle movement. Irritated nerves often respond badly to aggressive stretching. If you are not sure, err towards gentle movement rather than either extreme.
If it is settling week by week, giving it two to three weeks is reasonable. If it is not improving, getting worse, or you have nerve symptoms, get it assessed. Anything in the urgent list above should not wait at all.
Still have a question? Speak to our physiotherapist directly.
Call +44 7368 156076Most aching legs are muscles doing more than they are used to, and most of it settles on its own. The five questions above will get you to a sensible working answer, and the walking test will get you further than almost anything else you can do at home.
What I would take from all of this is that the pattern matters more than the intensity. Where it is, whether it is one leg or two, what stops it. Those tell you far more than how much it hurts on any given day.
And if there is one thing not to do, it is waiting out leg pain that comes with swelling in one calf.
If you have worked through this and still are not sure what you are dealing with, that is a perfectly normal place to end up. It is also exactly what an assessment is for. Home Physio Derbyshire provides home physiotherapy across Derby and Derbyshire, which means being assessed properly without a drive you may not feel up to. A first appointment will tell you what is going on, and if the honest answer is that you need a GP instead, we will say so.
We cover a thirty mile radius of Derby, including Belper, Ripley, Alfreton, Matlock, Chesterfield, Ilkeston and Mansfield, along with the surrounding areas of Derbyshire and Nottinghamshire. You can check coverage and session details on our areas we cover page, and there is no referral needed to book.
If you would rather ask a question before committing to anything, get in touch with our team and we will talk it through with you. Or book an assessment directly if you already know what you need.
