Muscle vs disc back pain How they tend to feel, other possible causes, and how a doctor tells them apart

“Did I pull a muscle, or is it a disc?” is one of the first questions people ask when the lower back flares. The answer matters because the plan, and how long recovery may take, can differ. At Precision Care Medical & Sports Performance, a physician examines you, explains which possible causes fit, and orders tests only when they will change the plan. The videos show the image-guided treatment our physicians use when a disc or nerve is involved; Ashley Marcus, MD appears in the first one.

Muscle vs disc back pain: how they tend to feel

• Muscle or ligament strain: often starts after lifting, twisting or a sudden movement; an ache, tightness or spasm across the lower back; tender to touch; worse with movement and better with rest; stays above the knee. See back pain after lifting and sprain vs strain.
• Disc problem: a deeper pain that can be worse with sitting, bending forward, coughing or sneezing. If the disc irritates a nerve root, pain, numbness or tingling can travel down the buttock and leg, sometimes below the knee (sciatica), and the leg may feel weak.

These are tendencies, not rules. A strain can be very painful, and a disc problem can cause back pain alone, so symptoms by themselves do not make the diagnosis. For spasms and tight muscle knots, see back muscle spasm treatment.

Other possible causes of lower back pain

• Facet joints: one-sided pain, worse leaning back or twisting; see facet joint pain
• Sacroiliac joint: pain low in the back near the dimples, sometimes into the buttock
• Spinal stenosis: leg pain or heaviness with walking that eases when you sit or lean forward; see spinal stenosis
• Arthritis of the spine: stiffness, worse in the morning; see lumbar spondylosis
• Problems outside the spine: the hip, the kidneys or other organs can refer pain to the back

How a doctor tells them apart

The exam checks where it hurts, how you move, and your strength, reflexes and sensation, plus specific tests such as a straight-leg raise that stretches the nerve. Most new back pain does not need a scan in the first weeks. Your physician orders an MRI or X-ray when there is leg weakness, pain that is not improving after about six weeks, or warning signs, and an EMG/NCV nerve test when it is unclear whether a nerve is irritated. See lower back pain treatment and our back pain doctor page.

How treatment differs

Both start with staying gently active and avoiding bed rest. A strain tends to improve within days to a few weeks with heat, movement and, if needed, physical therapy for back pain. A disc problem with leg pain can take six weeks to a few months; physical therapy is the core of treatment, and for some people spinal traction and decompression helps ease pressure on the nerve. Physical therapy and spinal traction and decompression are offered at both our Brooklyn and Staten Island offices. When leg pain is severe or not settling, a physician may suggest an epidural steroid injection; see epidural steroid injection for back pain. Pain procedures are performed at all three offices, and your physician explains where and when yours will be scheduled.

See a doctor promptly for leg weakness that is getting worse, and go to an emergency room for numbness in the groin, loss of bladder or bowel control, or back pain with fever.

Related care at Precision Care Medical & Sports Performance

A back pain doctor near you

Looking for a back pain doctor near me to find out whether it is a muscle or a disc? Precision Care Medical & Sports Performance sees patients at three offices, where our pain physicians, Ashley Marcus, MD in Brooklyn, Jake Stephen, DO on Staten Island and Yuri Gordin, MD in Manhattan examine you and order imaging or EMG/NCV only when it will help. Our Brooklyn pain management office on Shell Rd is close to Marine Park, Sheepshead Bay and Gravesend.

Our Staten Island pain management office on Richmond Rd serves New Dorp and Great Kills, and physical therapy is offered in Brooklyn and on Staten Island. In Manhattan, the Precision Care Spine & Pain Center in Midtown Manhattan is near Turtle Bay and Midtown East, and a direct ride from Washington Heights and Spanish Harlem. Request an appointment or call the office closest to you.

Questions patients ask

Educational only, not medical advice. These videos and this article explain common problems and treatments in general terms. They are not a diagnosis or a treatment plan for you. Results vary from person to person. See a qualified clinician about your own symptoms, and call 911 or go to an emergency room for an emergency.

← More videos and articles on the Precision Care Medical & Sports Performance blog