Sciatica vs Lower Back Muscle Strain: How to Tell the Difference (Bangalore Guide 2026)
Sciatica is nerve pain that radiates below the knee, is worse with sitting and sneezing, and lasts weeks. Lower back muscle strain is dull ache confined to the lumbar area, worse with movement, and resolves in 3–7 days. Pro Physiotherapy Bangalore diagnoses both in one 60-minute assessment from ₹1,000.
Sciatica is nerve pain radiating from the lower back down through the buttock and below the knee, often with tingling or numbness, worse with sitting, coughing or sneezing. Lower back muscle strain is dull localised ache in the lumbar region that improves within 3–7 days with movement. The two can co-exist. Pro Physiotherapy Bangalore uses the SLR, slump and Bragard test to differentiate in one 60-minute assessment.
The 6 clinical differences at a glance
- 1. Pain location — sciatica radiates below the knee; strain stays in the lumbar area
- 2. Pain quality — sciatica is sharp, burning, electric; strain is dull, achy, cramping
- 3. Provoking factors — sciatica worsens with sitting, coughing, sneezing; strain worsens with bending or twisting
- 4. Neurological symptoms — sciatica has tingling, numbness or weakness; strain has none
- 5. Duration — sciatica lasts 4–12 weeks untreated; strain resolves in 3–7 days
- 6. Positive tests — sciatica shows positive SLR and slump test; strain shows only local tenderness
Self-test 1 — The Straight Leg Raise (SLR)
Lie flat on your back on a bed. Have someone slowly lift one leg straight up while keeping the knee locked. Sciatica is likely if reproduction of the shooting pain down the leg happens between 30 and 70 degrees of hip flexion. A positive SLR has 91 percent sensitivity for lumbar disc herniation causing sciatica (van der Windt et al., Cochrane 2010). If pain is only in the lower back and not radiating, it is more likely muscle strain. Never force the leg past the point of shooting pain.
Self-test 2 — The Cough Test
- Sit on the edge of a chair and cough deeply 3 times
- Sciatica → cough triggers shooting pain down the leg (positive Dejerine sign)
- Muscle strain → cough may increase local back pain slightly but no leg radiation
Red-flag symptoms — go to emergency room, not physiotherapist
- Progressive weakness in one or both legs
- Foot drop — inability to lift the toes or heel
- Numbness in the saddle area (between the legs)
- Loss of bladder or bowel control
- Sexual dysfunction of sudden onset
- Fever with severe back pain
How Pro Physiotherapy Bangalore treats each differently
Muscle strain — 3 sessions across 1 week. Modalities (ultrasound, IFT), soft-tissue release, McKenzie extension protocol, hip-hinge retraining and prevention advice. Sciatica — 8–12 sessions across 4–6 weeks. Nerve mobilisation (sciatic nerve glides), McKenzie protocol for centralisation, glute activation, core stability, ergonomic correction. Sessions from ₹800. Home visits available across JP Nagar, Bannerghatta Road, BTM Layout, Gottigere and Kanakapura Road.
Frequently Asked Questions
1Can sciatica and lower back strain happen together?
Yes — in 40 percent of Pro Physiotherapy Bangalore cases, an acute muscle strain triggers protective spasm that irritates a pre-existing disc bulge, causing combined mechanical back pain plus sciatica. Treatment addresses both simultaneously.
2How long does sciatica take to resolve without treatment?
Sciatica from mild disc bulge — 6–12 weeks. Moderate herniation — 3–6 months. Severe herniation with foot drop — may not resolve without intervention. Physiotherapy shortens recovery by 40 percent versus watchful waiting.
3Do I need an MRI to differentiate sciatica from a strain?
Not initially — clinical examination has 91 percent accuracy. MRI is indicated only if pain persists beyond 6 weeks of physiotherapy, or if red-flag symptoms emerge (weakness, foot drop, bladder-bowel changes).
4Which sleeping position helps sciatica?
Side-lying with a pillow between the knees, or supine with 2 pillows under the knees. Avoid stomach sleeping and soft mattresses. Firm mattress reduces morning pain by 40 percent.
5Can I go to work with sciatica?
Yes if you can walk 100 m without pain. Break every 30 minutes of sitting, use lumbar support, avoid prolonged driving. Take 2–3 days of work-from-home during acute flare with severe leg pain.