Sciatica vs. Lower Back Pain: How to Tell the Difference and What to Do About It

By: Kelsie Mazur, DPT

Here I am, back on my soapbox talking about low back pain. Low back pain is the leading cause of disability worldwide, however, not all back pain is the same! This week we are breaking down the difference between generalized low back pain and sciatica. As a physical therapist, if I had a dollar for every time someone told me they have “sciatica,” I would be a very rich woman. That being said, many people assume that any pain radiating from the lower back means they have sciatica, but that’s not always the case. Understanding the key differences between sciatica and general lower back pain (LBP) is crucial for getting the right treatment and long-term relief.

Let's break this down: Sciatica refers to pain that radiates along the sciatic nerve, which runs from the lower back through the hips, buttocks, and down each leg. This feeling of radiating pain can be caused by several different things: a herniated disc, spinal stenosis, a weak or tight piriformis muscle, or spondylolisthesis (that’s word salad for when your vertebrae of your spine slowly shift forward due to repetitive stress). The symptoms of sciatica often include sharp, shooting pain that starts in the lower back and radiates down one leg, numbness or tingling in the leg or foot, weakness in the affected leg, and pain that worsens with prolonged sitting, standing, or certain movements such as bending forward or twisting. Sciatica symptoms typically occur on one side of the body.

On the other hand, lower back pain (LBP) is a broad term that refers to discomfort, stiffness, or aching in the lumbar spine. Unlike sciatica, it does not always involve nerve compression and is often caused by mechanical issues or muscle strain. Symptoms of lower back pain can sometimes mimic or even feel like sciatica, but usually they typically involve a dull, aching pain localized in the lower back, stiffness (especially in the morning or after prolonged sitting), pain that may radiate but does not travel past the buttocks, and symptoms that often improve gentle movement.

Treatment approaches for these conditions also differ. For sciatica, physical therapy focuses on nerve glides, mobility exercises, and postural training to reduce nerve irritation. Strengthening the core, performing manual therapy techniques, and modifying activities to avoid prolonged sitting can also be beneficial. In contrast, lower back pain treatment typically includes postural training, stretching, strengthening exercises, and ergonomic adjustments. Manual therapy, soft tissue work, and core strengthening exercises help improve spinal support and prevent recurrent pain episodes.

While mild cases of back pain can often resolve with rest and self-care, it is essential to seek professional help if you experience severe, persistent pain lasting more than a few weeks, progressive leg weakness, worsening numbness or tingling, or loss of bowel/bladder control (this is a medical emergency). A physical therapist can help identify the root cause of your pain and create a personalized treatment plan to help you move better and feel stronger.

The most important message of this blog: Although sciatica and lower back pain share some similarities, they are distinct conditions that require different approaches to treatment. So, you went to physical therapy for your sciatica or low back pain, did all the exercises, maybe even got a few massages, and… nothing? Or worse, it got better for a little while but then came back with a vengeance? So frustrating!

But here’s the thing—just because one round of PT didn’t give you the miracle cure doesn’t mean you’re doomed to a life of back pain and awkwardly wincing every time you tie your shoes. It just means we might need to dig a little deeper.

Think of it like this: If your car keeps making a weird noise and the mechanic just turns up the radio so you can’t hear it anymore, that doesn’t mean the problem is fixed. It just means the root cause wasn’t addressed. The same goes for your back! If PT didn’t work before, it might be because the real issue wasn’t identified. Maybe the pain in your back is actually coming from your hips, your core weakness, or how you move throughout the day.

That’s why a skilled physical therapist won’t just chase your symptoms—they’ll do a full-body investigation to figure out why you’re hurting in the first place. Once we get to the root cause, we can create a plan that actually works for you.

So don’t lose hope! The right approach, with the right therapist, can make all the difference. Let’s get you back to moving, feeling strong, and doing the things you love, without your back putting up a fight!

Did you know that we offer free 1-on-1 injury screens? Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Kelsie at Kelsie@wattagept.com. I would be happy to help you start the process of living a life free from pain.