Low Back Pain vs. Sciatica: What’s the Difference?

April 08, 2024

A female massage therapist massaging a male patient’s back with both hands

Eight in 10 people will be affected by lower back pain at some point in their life, and as many as 4 in 10 will get sciatica. It can be easy to confuse the two conditions because they share many of the same symptoms.

Both low back pain and sciatica can occur when nerves are pinched or irritated. Both can be mild or severe. Both conditions can either resolve quickly or become chronic and limit daily function. And both can become more frequent as you age. So what’s the difference?

“Initially it can be difficult to determine whether your problem is low back pain or sciatica. The tricky part is they often go together. But low back pain and sciatica are distinct conditions,” says University Hospitals physical medicine & rehabilitation specialist Antimo Paul Gazzillo, MD.

Low Back Pain: Symptoms & Causes

The symptoms of low back pain can include achy or sharp pain, as well as stiffness and limited range of motion. The symptoms occur in the lower back, but typically don’t extend past the buttocks.

Low back pain can be caused by the muscles, nerves or the spinal structure. In younger patients, low back pain is usually the result of a back injury or muscle strain or sprain. In older patients, low back pain commonly occurs because of arthritis, degenerative disc disease or spinal stenosis (the narrowing of the spinal canal, putting pressure on the nerve inside it).

Sciatica: Symptoms & Causes

The symptoms of sciatica can include burning, stinging or sharp pain that begins in the low back and shoots down the leg. Most often, sciatica is felt on the back of the leg and only on one side of the body. Sciatica can be infrequent and irritating or severe and disabling. If the condition is severe, there can be numbness or tingling. If the nerve is damaged over time, it can cause weakness in the leg or foot.

Common causes of sciatica include a bulging or herniated disc, or the worsening of arthritis, spinal stenosis or degenerative disc disease due to aging. Other causes can include vertebra misalignment, an injury to the lower back or hip, or compression of the sciatic nerve by the piriformis muscle in the buttock.

“The biggest difference between low back pain and sciatica is that typically low back pain is going to be just pain across the lower back, at or just above or below the pant line,” says Dr. Gazzillo. “Sciatica typically travels down the leg, potentially into the foot and ankle. Back pain often affects movement, but severe sciatica can cause numbness, tingling or weakness in the leg or foot.”

Treatment Options

For both low back pain and sciatica, rest and time are critical. It’s important to avoid activities that make symptoms worse. Try over-the-counter medications like ibuprofen or acetaminophen and ice or heat packs.

If pain persists or limits everyday activity despite these efforts, see a doctor. Following an exam, the doctor might use X-rays, MRI imaging or a nerve conductivity test (electromyography) to help diagnose the problem. Treatment options could include physical therapy, chiropractic care, medical massage or acupuncture, along with muscle relaxers, medications for nerve pain or steroids.

Injections are offered to patients who don’t improve with conservative treatments or are unable to participate in everyday activity due to the pain. Surgery is an option if other treatments aren’t effective.