Is Your Back Pain Coming from Your Spine or Your Nerves? How to Tell
Back pain is one of the most common reasons people seek medical care, yet the source of that pain can be surprisingly hard to pinpoint. Two major pain generators often get confused: the structures of the spine itself and the nerves that travel through it. Understanding the difference helps you know what you’re dealing with, what you can do at home, and when it’s time to see a specialist.
This guide explains how spinal pain behaves, how nerve pain behaves, and the signs that tell you which one may be affecting you.
Why It Matters Where Your Pain Comes From
Your spine is built from bones, discs, ligaments, facet joints, and stabilizing muscles. Any of these can become irritated or inflamed, causing what doctors call axial pain — pain centered in the back itself.
Your nerves, on the other hand, carry signals from the spine out to the legs or arms. When a nerve root is compressed or inflamed, the pain behaves very differently. It tends to spread or radiate along a specific path.
Knowing which type you’re dealing with leads to very different treatment plans. Someone with irritated facet joints may respond well to targeted care or strengthening, while someone with nerve irritation may need a different approach. A correct diagnosis prevents frustration and can shorten the time to relief.
Signs Your Pain Is Coming from the Spine
Pain that starts in the structures of the spine often has distinct patterns. People commonly describe:
- A dull or aching discomfort in the lower back
- Pain that worsens when standing, bending backward, or twisting
- Morning stiffness that loosens over the day
- Pain focused in the middle or lower back rather than the legs
Facet joints can cause pain on either side of the spine, often worse with arching backward or standing for long periods.
Discs may cause pain that intensifies when sitting, bending forward, or lifting.
Vertebral endplates can become irritated and produce deep, persistent low back pain that stays mostly in the back or buttocks. This type of pain is sometimes evaluated for treatments like the Intracept® procedure, which targets the basivertebral nerve.
When spinal structures are the main source, pain generally stays local rather than radiating down the leg.
Signs Your Pain Is Coming from a Nerve
Nerve pain, or radicular pain, has a very different feel. It often includes:
- Sharp, electric, or shooting pain
- Pain that travels from the back into the buttock, thigh, calf, or foot
- Numbness or tingling
- Burning sensations
- Leg weakness or instability
Radicular pain follows predictable patterns depending on which nerve is irritated. For example:
- Irritation of the L5 nerve can cause pain along the outer leg and into the top of the foot.
- Irritation of the S1 nerve can produce calf pain and difficulty pushing off the foot.
Nerve pain can worsen when sitting for long periods, coughing, or bending forward. Episodes may come and go depending on inflammation.
When to See a Pain Specialist
Back pain that resolves within a few days is common. But evaluation is important when:
- Your pain lasts more than four to six weeks
- You have numbness, tingling, or radiating leg pain
- Your symptoms interfere with sleep or daily activities
- You notice leg weakness
- Symptoms improve only briefly with home care
A specialist can determine whether your symptoms come from spinal structures or nerve roots and recommend targeted treatment. At Oregon Pain & Spine Specialists, the focus is on identifying the true source of pain and treating it directly with minimally invasive, drug-free options.
Frequently Asked Questions
Does nerve pain feel different from muscle pain?
Yes. Muscle pain is typically sore or tight. Nerve pain is often sharp, burning, or electric and usually travels down the leg. Muscle pain tends to stay in one area.
How do doctors determine where my pain comes from?
Your doctor evaluates your symptoms, physical exam findings, and, when needed, imaging. Specific movements and reflex tests help identify whether the source is spinal or nerve-based.
Is nerve pain always caused by a herniated disc?
No. Disc herniation is common, but nerves can also be irritated by inflammation, arthritis, or narrowing of the spinal canal.
Will I need an injection right away?
Not necessarily. Treatment plans are individualized. Many patients start with targeted exercises or simple changes. Injections may be recommended if symptoms persist.
Can spine-based pain turn into nerve pain?
It can. If inflammation or disc pressure affects a nearby nerve root, symptoms may shift from localized pain to leg pain. Early evaluation helps prevent this progression.
