Is My Lower Back Pain a Pulled Muscle or a Disc? How to Tell
Dr. Rob Letizia PT, DPTShare
Medically reviewed by Dr. Rob Letizia, PT, DPT · Doctor of Physical Therapy, 25+ years treating spine & orthopedic conditions · Last reviewed 2026-10-05
You bent to pick something up, or finished a heavy set, or simply got out of the car wrong, and now your lower back has seized. The question that follows is almost always the same one: did I just pull a muscle, or have I done something to a disc?
It is the right question, because the two behave differently and the next few weeks should look different depending on the answer. You cannot settle it for certain from your sofa, but you can get much closer than most people think — and you can learn the handful of signs that mean it is not a wait-and-see problem at all.
How can I tell if my lower back pain is a muscle or a disc?
Ask where the pain goes, not just how bad it is. Intensity is a poor guide: a back strain can be ferociously painful, and a disc problem can start as a dull ache. The pattern is what separates them.
Most lower back pain is mechanical — a muscle strain, a ligament sprain, an irritated disc or joint — which means it has good positions and bad positions and it responds to load, movement and time. The clinical practice guideline physical therapists work from sorts back pain by how it behaves, not by a scan (George et al., Journal of Orthopaedic & Sports Physical Therapy, 2021). The four questions below are how we start that sort in the clinic.
The 4-Question Muscle-or-Disc Check
Answer these honestly. One answer settles nothing; the pattern across all four is what matters.
- Where does the pain go? Pain that stays in the lower back, or aches into the buttock, behaves like a muscle or ligament. Pain that travels below the knee — down the back or side of the leg, sometimes into the foot — points toward an irritated nerve root, and in the lower back that is most often a disc.
- What do sitting and bending forward do to it? A strain is usually sore with particular movements and easier at rest. Pain that builds the longer you sit, and is worse bending forward, leans toward the disc.
- Does a cough or a sneeze send it down the leg? A cough or sneeze that jolts the back alone is common with any acute back pain. One that shoots pain into the leg is a disc-and-nerve sign.
- Is there numbness, tingling or weakness in the leg or foot? Muscles hurt; they do not make your foot go numb. Pins and needles, a patch of numb skin, or a foot that catches or feels weak means a nerve is involved.
If every answer points to the back alone, a strain is the likelier story. If two or more point down the leg, treat it as a disc problem until an exam says otherwise.
Muscle or Disc: The Side-by-Side Table
| Sign | Usually a muscle or ligament strain | Usually the disc and nerve root |
|---|---|---|
| Where it hurts | Lower back, one or both sides; may ache into the buttock | Lower back and/or leg; often one-sided; can travel below the knee |
| Leg symptoms | None below the knee | Pain, numbness or tingling down the leg, sometimes into the foot |
| Sitting and bending forward | Sore with certain movements, easier at rest | Often worse the longer you sit and when bending forward |
| Cough or sneeze | May jolt the back | Can shoot pain into the leg |
| Touch | The muscle itself is often tender to press | The back may not be tender where the leg pain is |
| Strength and sensation | Normal | May have a weak foot or ankle, or a numb patch of skin |
| What the exam looks for | Pain with stretching or contracting the muscle | Leg symptoms that move toward the spine with certain repeated movements (centralization) |
Real backs do not always read cleanly from one column. Plenty of people have a sore, guarded back and a mild disc irritation at the same time. That is exactly why the table is a starting point and the exam is the answer.
Does a pulled back muscle cause leg pain?
A strained back muscle can refer a dull ache into the buttock or the top of the thigh. What it does not normally do is send shooting pain below the knee, or cause numbness, tingling or weakness in the leg or foot. Those belong to a nerve. In the lower back, the commonest reason a nerve root gets irritated is a disc — which is what people mean by sciatica.
If that is where your symptoms are, our herniated disc treatment guide covers what to expect from care.
Is it normal to have lower back pain after deadlifts?
Some of it is. General soreness across both sides of the lower back the day after a heavier session, a new rep range or a lift you have not done in a while — soreness that loosens as you warm up and fades over the next few days — is the ordinary response to training load.
These are not training soreness:
- a sharp pain you felt during a specific rep, often with a sense that something “went”;
- pain on one side that makes sitting, driving or putting on socks hard;
- any pain, numbness or tingling travelling into the leg;
- soreness that is getting worse, not better, over the following days.
Run the 4-Question Check on it. If it reads as a disc, stop loading the deadlift until you have been assessed. If you already know you have a disc problem and want to keep lifting, read strength training with disc injuries.
Can an MRI tell if my back pain is a muscle or a disc?
Less than you would hope. Disc changes are extremely common in people with no back pain at all. A review of 33 studies and 3,110 people without symptoms found disc bulges in 30% of 20-year-olds, rising to 84% of 80-year-olds (Brinjikji et al., American Journal of Neuroradiology, 2015). A scan can find a bulge that has nothing to do with your pain.
That is why guidelines advise against routine imaging for low back pain without red flags (Chou et al., Annals of Internal Medicine, 2007). Imaging earns its place when the exam suggests a compressed nerve that is not improving, or when one of the red flags below is present.
Can you see a herniated disc on an X-ray?
No. An X-ray shows bone. It can show the space between two vertebrae narrowing, but it cannot show the soft disc material or whether it is pressing on a nerve. If someone needs to see the disc, that is an MRI — and most people with new back pain do not need one early.
How long should I wait before getting it checked?
The 2-to-3-Week No-Change Rule
A straightforward strain should be trending better — not gone, but moving the right way. If you have had two to three weeks of sensible care and there is no change whatsoever, not slower than you hoped but genuinely nothing, that is information. It means the working explanation is probably wrong, and it is time for an exam.
Do not wait the two to three weeks if the pain is going down the leg with numbness or weakness, or if anything in the next section applies.
When should I worry about lower back pain?
Go to an emergency department today for:
- numbness in the saddle area — the groin, inner thighs, or the area you sit on — including noticing it when you wipe;
- a change in bladder or bowel control, or new difficulty starting or stopping urination;
- weakness in both legs, or leg weakness that is getting worse.
See a doctor promptly for:
- fever or chills together with back pain;
- unexplained weight loss or night sweats alongside the pain;
- pain that is the same lying, sitting and standing, or that reliably wakes you rather than just making it hard to get comfortable.
Those are not muscle-or-disc questions. Our back pain red flags guide explains each one.
What a physical therapist actually checks
The first visit answers the question you came in with. Dr. Rob Letizia, PT, DPT, takes the history above, then tests strength, reflexes and sensation in the legs, checks whether the leg will tolerate a straight-leg raise, and uses repeated-movement testing from the McKenzie method to see whether your symptoms centralize — leg pain retreating toward the spine — which is a favourable early sign. Rob is McKenzie trained.
You leave knowing which column you are in, what to do and avoid this week, and whether anything needs to go to a physician.
Started with an AI assistant? Bring the plan in.
ChatGPT, Gemini and Claude will all give you a sensible list of muscle-versus-disc signs. What none of them can do is press on your back, test the strength in your foot, or watch what happens to your leg pain when you repeat a movement — and those are the details that decide which plan is right.
Bring the plan you have been following and anything you have been told about your back. We will tell you which parts of it fit what we find, and which do not.
Book a Plan Check · one visit, in person at our Wayne, NJ clinic. We test the plan you are already following, tell you which parts to keep, and correct what is provoking it · call or text (973) 689-7123. Reviewed by Dr. Rob Letizia, PT, DPT · 11 years leading Spectrum Therapeutics, 25 years in practice, 300+ five-star patient reviews.
Frequently asked questions: pulled muscle or disc?
How can I tell if my lower back pain is a muscle or a disc?
Look at four things: where the pain goes, what sitting and bending forward do to it, whether coughing or sneezing sends it down the leg, and whether there is numbness, tingling or weakness in the leg or foot. Pain that stays in the back and is sore to touch usually behaves like a muscle or ligament strain. Pain that travels below the knee, flares with sitting or bending, or comes with leg numbness or weakness points toward the disc and the nerve root. That is a pattern, not a diagnosis; a hands-on exam confirms it.
Does a pulled back muscle cause leg pain?
A strained back muscle can refer an ache into the buttock or upper thigh, but it does not normally cause shooting pain below the knee, or numbness, tingling or weakness in the leg or foot. Those symptoms suggest an irritated nerve root, most often from a lumbar disc.
Is it normal to have lower back pain after deadlifts?
General soreness across both sides of the lower back the day after a heavier or new deadlift session, which eases as you warm up, is the usual training response. A sharp pain you felt during a specific rep, pain on one side that makes sitting worse, or any pain, numbness or tingling travelling into the leg is not training soreness and is worth having assessed before you load the lift again.
Can an MRI tell if my back pain is a muscle or a disc?
Not on its own. Disc bulges are common in people with no back pain at all: a review of 33 studies and 3,110 people without symptoms found disc bulges in 30% of 20-year-olds, rising to 84% of 80-year-olds (Brinjikji et al., 2015). Guidelines advise against routine imaging for low back pain without red flags (Chou et al., 2007). An MRI matters when the exam suggests nerve compression that is not improving, or when red flags are present.
Can you see a herniated disc on an X-ray?
No. An X-ray shows bone, not the soft disc or the nerve. It can show narrowing of the space between two vertebrae, but it cannot show whether a disc is pressing on a nerve. That takes an MRI, and most people do not need one early.
When should I worry about lower back pain?
Go to an emergency department the same day for numbness in the saddle area (groin, inner thighs, the area you sit on), a change in bladder or bowel control, or weakness in both legs or leg weakness that is getting worse. See a doctor promptly for fever or chills with back pain, unexplained weight loss, or pain that is the same lying, sitting and standing or reliably wakes you at night.
Do I need a referral to see a physical therapist for back pain in New Jersey?
No for most plans: New Jersey allows direct access to physical therapy. Any Medicare plan, including Medicare Advantage and Medigap plans, requires a doctor's script.
Lower back pain care in Wayne and Northern New Jersey
At Spectrum Therapeutics of NJ in Wayne, we see lower back pain from across Passaic County and Northern New Jersey — strains, disc problems and the many backs that are a bit of both. Care is one-on-one with Dr. Rob Letizia, starts with the exam that answers the muscle-or-disc question, and is built on how your back behaves rather than what a scan shows. New Jersey allows direct access to physical therapy; any Medicare plan requires a doctor's script.
Call us at 973-689-7123 to book an evaluation.
Related Services at Spectrum Therapeutics
- Back pain treatment in Wayne, NJ
- Herniated disc treatment in Wayne, NJ
- Lower spine rehabilitation in Wayne, NJ
- Sciatica treatment in Wayne, NJ
Questions? Call (973) 689-7123 or schedule your appointment online.
