Two patients describe the same thing: pain in the buttock that runs down the leg, worse when they get up from a chair. One has a lumbar nerve root under pressure. The other has a hip joint that has been quietly wearing for a decade. Treated as the same problem, one of them will get nowhere.
What sciatica usually looks like
True sciatic pain follows a nerve path. It often travels below the knee, sometimes to the foot, and is commonly described as burning, electric or shooting rather than aching. Coughing, sneezing or sitting for long stretches can spike it. Numbness, tingling or weakness in a specific pattern points strongly toward nerve involvement.
What hip-driven pain usually looks like
Hip joint pain more often sits in the groin, the front of the thigh, or deep in the buttock, and typically stops above the knee. It is aggravated by weight-bearing, pivoting, and getting in and out of a car. Patients describe stiffness in the morning and a catching or grinding sensation. It aches rather than burns.
How the exam separates them
A straight-leg raise that reproduces leg pain suggests nerve tension. A log-roll or FABER test that reproduces groin pain suggests the joint. Reflexes, strength testing and dermatomal sensory testing add nerve-specific evidence. Range-of-motion restriction with internal rotation loss points at the hip.
Mixed pictures are common, particularly in patients over sixty, and both can be present at once. In that case the exam determines which one is driving today's limitation, and the plan addresses it first.
Why the distinction changes the plan
Nerve-driven pain may respond to nerve-directed care: targeted therapy, epidural or selective injections where indicated, and modalities that reduce irritation. Joint-driven pain leans toward loading strategy, gait work, intra-articular options where appropriate, and occasionally an orthopedic referral.
Both plans are individualized after the clinician evaluation, and neither carries a promised outcome. What the distinction buys you is that the first six weeks of care are aimed at the right structure.
When to be seen
Get evaluated if leg pain has persisted past a few weeks, if it is worsening, or if you notice weakness, numbness or a foot that drags. Evaluations are available seven days a week in Silver Spring, with telehealth follow-ups statewide.