Lower Back Pain vs Sciatica: Fundamental Differences Explained

Lower back pain and sciatica are very different. The main difference between lower back pain vs sciatica lies in what is causing the pain.

Lower Back Pain is From Structures IN the Back

Common structures that cause pain in the lower back include facet joints, paraspinals, discs, and the SI joint. These structures often cause pain that is deep, achy, throbbing, and sharp when irritated or inflamed. My patients often report that their back pain improves over time and tends to ebb and flow based on activity levels or even the time of day. This pain usually does not radiate past the knee or down to the foot. However, lower back pain can occasionally radiate into the buttocks and/or thighs, depending on which structures or tissues are involved.

You Can Also Have Pain in Your Lower Back From Diseases or Pathology

The most common being arthritis or osteoarthritis and degenerative disc disease. They often cause stiffness, achiness, and are related to age. The older you are the more likely you are to have these things. No, you don't need an MRI to help you figure out what specifically I going on! 

In fact arthritis starts in our late 20's! 

You Should Be Worried About Back Pain When You Have Certain Symptoms

Lower back pain and sciatica are very common and, 90% of the time, do not require extra concern. However, there are several red flags that you and your provider should be mindful of. If you notice any of the signs or symptoms listed below, please seek medical attention immediately, as they may indicate a more serious injury or condition.

• Incontinence (Loss of bowel or bladder control)
• Progressive or severe weakness in one or both legs 
• Unexplained weight loss
• Night pain, fever, night sweats
• Numbness or tingling in the genital or anal area 
• Recent history of cancer

How Do I Know If My Lower Back Pain Is Sciatica?

Sciatica is most often caused by compression of one of the nerve roots that make up the sciatic nerve as it exits the spine (L4-S3). The two most common causes of nerve root compression are disc herniation and spinal stenosis. Because the pain is directly caused by compression and irritation of nerve tissue, its quality and distribution will differ from that of lower back pain.

Sciatica is Collection of Symptoms: Nerve Pain, Sensation Changes and Weakness in the Leg or Foot and Changes in Reflexes

Nerve pain is often described as sharp, stabbing, or even burning, as if touched by a hot rod. It can also feel like an electric shock traveling down the leg. Sounds fun, right? Another characteristic of nerve involvement is changes in sensation and muscle strength. With sciatica, you may experience altered sensations such as tingling or numbness along the course of the nerve. There may also be muscle weakness in groups innervated by branches of the sciatic nerve, including the glutes, hamstrings, and foot and ankle muscles. One of the most common areas of weakness associated with sciatica is ankle dorsiflexion, which can lead to foot drop.

Reflexes are harder to test on your own, but for a provider such as a physical therapist or doctor to determine if you have sciatica, your reflexes must be tested.

You Can Test For Sciatica At Home Using the Slump Test

Slump test

1. Sit in a chair 
2. Slump forward and bring your chin to your chest
3. Slowly straighten one leg and lift your toes
4. Can repeat with the other leg for comparison 

Positive test suggesting sciatic nerve involvement: Increase in pain and/or radiating pain into the leg, onset of tingling or numbness. Symptoms of sciatica are often aggravated by prolonged sitting or standing, causing increase in pain and/or numbness or tingling in the leg. 

Nerve glides and At Home Treatment if You have sciatica

If you feel that you have sciatica then try this treatment! 

How Do I know It's Sciatica And Not Something Else?

Sciatica is a collection of signs and symptoms, so when you experience them, it can be easy to identify the cause of your pain. That being said, there are a lot of structures in your back, spine, and hips that can contribute to pain. When I treat patients with sciatica concerns or sciatic nerve pain, I look out for piriformis syndrome and stenosis.

It can be difficult to figure this out on your own, so if things are not improving as expected, consider seeing a physical therapist for a comprehensive evaluation and treatment plan.

Here Is What I Recommend to Calm Down a Sciatica Flare Up

If you are experiencing a sciatica flare-up, you have a few options. Visiting a physical therapist can be a wise choice, especially if you want to determine the root cause of the problem and prevent future recurrences for long-term relief.

By the way, in nearly all states you don't need a referral for PT, just call! 

However, if you are looking for immediate relief from a sciatica flare-up at home, there are a few simple remedies you can try on your own.

My Go-To Plan for Immediate Relief From Sciatica

If you are experiencing pain and tingling down the leg, you may have many questions and be searching for relief. These tips have helped many of my patients find relief and gain confidence in their recovery.

1. Avoid Aggravating Activities 

My first recommendation is always to avoid aggravating activities during the acute phase of a flare-up. For those with disc herniations, this may mean avoiding prolonged sitting, while for those with stenosis, it may mean limiting standing. You don’t want to continue irritating the sciatic nerve and prolonging recovery. However, this restriction is only temporary, as the ultimate goal is to return to all your daily activities without pain or limitations.

2. Consider Non-Steroidal Anti-Inflammatory Medications (NSAIDS)

I am a physical therapist, and while I don’t often recommend medication, certain medications can be very effective in managing pain and inflammation during the acute phase. Why suffer more than necessary? Always use medications as directed and never long-term without consulting your physician.

3. Get Up And Move

Walking is a great full-body movement that promotes healing around the nerve. Nine times out of ten, my patients feel better when they move. Walking improves blood circulation to healing tissues, reducing inflammation and delivering essential nutrients for tissue repair. Simply put, although not as glamorous as other forms of exercise, walking offers numerous benefits, including pain relief for sciatica

4. Comfortable Position With Hot Pack

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The research isn’t 100% conclusive on whether heat or ice is better for sciatica or back pain. However, the trend leans toward using heat for back pain and related conditions. My general recommendation is to apply heat for 15 to 20 minutes to the area where you feel discomfort. Most of the time, this is the lower back, as that is where sciatica originates, but don’t hesitate to use heat on your leg, glute, or hamstring as well. A common position for applying ice or heat is sitting or lying down. If you have disc issues, try lying on your belly!

Here is a hot pack that I have used and it was very useful for reducing spasm and improving tissue quality.

In summary, sciatica and lower back pain can be frustrating, but the good news is that relief is possible. Understanding the key differences between them is the first step toward effective treatment and long-term recovery. By making small changes—such as avoiding aggravating activities, staying active, and using heat—you can take control of your symptoms and start feeling better.

If you're looking for more guidance on managing sciatica, I’ve put together a free Sciatica PDF packed with actionable steps and expert advice to help you reduce pain and regain mobility. Download it today and take the first step toward lasting relief!