Think You Have Sciatica? It Might Be One of These 5 Imposters

If you’ve ever had pain that shoots down your leg, someone has probably told you, “That sounds like sciatica.” And while they might not be wrong, there’s a good chance they’re not entirely right either.

As a sports chiropractor, I see people all the time who think they have sciatica — and sometimes they do. But just as often, their pain is coming from something completely different.

Let’s clear up the confusion.

True sciatica is caused by irritation of the sciatic nerve, most commonly from a herniated disc in the lumbar spine. But leg pain that feels like sciatica can actually be caused by several other conditions. These are the top 5 “imposters” I see in clinic — and how to tell them apart.

1. Herniated Disc — The Real Sciatica

What it is:
This is the classic version. A herniated disc occurs when the inner gel-like material of a spinal disc pushes out through the outer layer and presses on the sciatic nerve.

How it feels:
A sharp, electric pain that starts in the lower back and travels through the buttock, down the back of the thigh, and possibly all the way to the foot. It may come with numbness, tingling, or weakness.

How we treat it:
Spinal adjustments help take pressure off the nerve, while targeted rehab strengthens the core and improves spinal stability. Soft tissue therapy can also calm down the irritated area.

Herniated Disc

2. Facet Joint Syndrome — A Joint That Feels Like a Nerve

What it is:
Facet joints are the small joints in the back of your spine that help control movement. When they get inflamed or irritated, they can cause pain that mimics sciatica.

How it feels:
Pain usually starts in the lower back and may radiate into the buttocks or thigh, but it rarely goes below the knee. It typically gets worse with twisting or arching backward.

How we treat it:
Gentle spinal manipulation can restore motion to these joints, and we often add stability and posture exercises to reduce strain.

Facet Joint Pain Referral Pattern

Notice how the pain extends into the thigh.

3. SI Joint Pain — The Pelvis Troublemaker

What it is:
The sacroiliac (SI) joints connect the bottom of your spine to your pelvis. When these joints become stiff, hypermobile, or inflamed, they can cause lower back and leg pain that’s easy to mistake for sciatica.

How it feels:
Dull, aching pain near the tailbone, often spreading into the buttock and thigh. Pain may worsen when standing up from a seated position or climbing stairs.

How we treat it:
Chiropractic adjustments help realign the pelvis, and strengthening exercises for the core and hips help stabilize the joint long term.

SI Joint Pain Referral Patterns

4. Piriformis Syndrome — A Muscle That Messes With Your Nerve

What it is:
The piriformis is a small muscle deep in the buttock. It sits right over the sciatic nerve. If it gets tight or inflamed, it can compress the nerve and mimic sciatica.

How it feels:
A deep ache or burning in the buttock, sometimes radiating down the back of the leg. It tends to worsen with sitting or activities like running or climbing.

How we treat it:
Stretching, myofascial release, and mobility work are key. We also strengthen the glutes and hips to keep the piriformis from overworking.

Piriformis Syndrome

The piriformis can pinch the sciatic nerve and create a “sciatica” type sensation.

5. Myofascial Trigger Points — Knots That Fool You

What it is:
Trigger points are tight, irritable spots in the muscles or fascia. When activated, they can refer pain to other areas — including the leg.

How it feels:
A dull, aching, sometimes burning pain that starts in the lower back or glutes and travels down the leg. Pressing on the muscle often recreates the pain.

How we treat it:
Manual therapy, dry needling, and soft tissue techniques relieve the trigger points. Exercises to improve posture and movement patterns help prevent them from coming back.

Myofascial Trigger Points. Take note of the pain referral.

Final Thoughts

So — do you really have sciatica? Maybe. But it might also be one of its five imposters. The key is getting a proper diagnosis so you’re not wasting time treating the wrong problem.

The good news? Most of these conditions respond incredibly well to chiropractic care. Whether it’s a disc, a joint, or a muscle, the right treatment starts with the right understanding.