The Differences Between Lumbago and Sciatica

Lumbago and sciatica are musculoskeletal disorders that are closely related, but their etiology isn't exactly the same. Here, you'll find out why.

Written and verified by el biólogo Samuel Antonio Sánchez Amador.

Last update: 01 August, 2023

Musculoskeletal disorders are extremely common in general society. Lower back pain or lumbago is the most common of all, as it’s estimated that up to 80% of the adult population suffers from it at some point in their life. It’s essential to know the differences between lumbago and sciatica because despite sharing symptoms to some extent, they’re not the same thing.

Back pain is usually acute and resolves on its own in a few days or weeks, something that also happens with sciatica if it’s addressed properly. However, their etiology and clinical approach are somewhat different. Learn with us the distinctions between these disorders and how to perceive them before they become chronic.

Lumbago, sciatica, and other disorders

First of all, it should be noted that both lumbago and sciatica are included in the group of musculoskeletal disorders. These represent a group of injuries or pain in the joints, ligaments, muscles, nerves, tendons, and structures that support the trunk and extremities (bones).

Musculoskeletal disorders arise from the interaction between organs or tissues with ergonomic, psychological, social, and occupational factors. The World Health Organization (WHO) shows us some revealing figures about this pathological group:

• Musculoskeletal disorders can be expressed in the form of more than 150 diseases that affect the locomotor system. They range from mild injuries (such as contractures) to degenerative congenital diseases of a muscular nature, such as Duchenne muscular dystrophy.
• Approximately 1.7 billion people have a musculoskeletal disorder worldwide. Lumbago or lower back pain is the most common of all, affecting 568 million adults in total.
• These disorders represent the leading cause of disability worldwide. Lower back pain once again is at the top of this front, as it’s the number one reason for early retirements, lower levels of well-being, and loss of autonomy in 160 countries.
• Disability caused by musculoskeletal diseases is on the rise. In part, this is because the world’s population is getting older.

Lumbago or lower back pain leads the statistics in this field, but sciatica, myopathies, arthritis, osteoarthritis, and many other disorders are very present in general society. In addition, most of them have chronic and persistent discomfort, so they’re quite difficult to treat in general.

The differences between lumbago and sciatica

Despite the fact that both pictures are in the same pathological group, it’s important to emphasize that they’re not exactly the same. In the following paragraphs, we’ll show you how they differ by section. Keep reading!

1. Different but complementary clinical pictures

As indicated by the United States National Library of Medicine, lower back pain is pain that’s felt in the lower back (between the L1 and L5 vertebrae). In practical terms, the discomfort is felt in the lower back, located between the last ribs and the gluteal area. It can affect ligaments, muscles, vertebral discs, and vertebrae.

Lower back pain isn’t a specific disease, but rather a symptom or complaint that can be caused by certain conditions of varying severity. Most cases don’t have a specific cause, but it’s usually attributed to a muscle strain or tear. This can be caused in turn by stress, obesity, physical exercise, and many other extrinsic factors.

On the other hand, the Mayo Clinic defines sciatica as “a pain that radiates along the path of the sciatic nerve, which branches from the back to the inside of each leg.” This condition almost always affects one side of the body and 90% of the cases arise from a herniated disc.

The first of the differences between lumbago and sciatica is very easy to understand: Lumbago is a pain of a more muscular nature, while sciatica is characterized by a much more dominant discomfort at the nervous level. In any case, it should be noted that both pains can occur at the same time, giving rise to the clinical entity known as lumbosciatica.

2. The pathophysiology of lumbago is usually muscular, while that of sciatica is nervous

We’ve seen that both paintings have a slightly different nature, but we’re interested in dwelling a little more on the structures involved in each of them. In lumbago, the lumbar vertebrae (L1 to L5), the sacrum, the intervertebral fibrocartilaginous discs, or various muscles (multifidus, erector spinae, and others) are affected to a greater or lesser extent.

Most cases of lower back pain are usually explained by stiffness or straining of the lumbar muscles, which can also affect adjacent bones, tendons, and nerves. The pain occurs due to the transmission of electrical signals originating in the spinal ganglia, a group of nodules located in the dorsal or posterior roots of the spinal nerves.

As indicated by the Statpearls medical portal, sciatica pain is much more specific. This is usually caused by direct compression of the L4-L5 lumbar nerves or the S1-S2-S3 sacral nerves. These nerve roots join in the pelvic cavity to create the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg.

Sciatica occurs when any of the nerves that lead to the sciatic nerve or the sciatic nerve itself are damaged in any part of its course. Age, obesity, and profession can increase the risk of suffering from sciatica throughout life. Again, lower back pain has a greater muscle load than sciatica (although it also involves nerve receptors).

3. Sciatica is almost always caused by a hernia, but lumbago is more diffuse

As indicated by medical clinics, 90% of cases of low back pain are idiopathic, that is, they don’t have a specific cause. In any case, cases can be included in one of the following categories:

• Mechanical: In most cases the underlying reason for lower back pain is mechanical, that is, due to injury or damage to the spine, intervertebral discs, or soft tissues (muscles). This is almost always a strain in the quadratus lumbar or paraspinal muscles.
• Degenerative: Osteoarthritis and other degenerative processes associated with age can cause tendons and ligaments to suffer over time, which causes friction between bones (in this case between vertebrae). For this reason, lower back pain is more common in adults than in young people.
• Inflammatory: Some autoimmune processes attack the structures of the spine, as could occur in ankylosing spondylitis (associated with the HLA-B27 antigen). This causes chronic pain and inflammation that manifest in the form of lower back pain, among other clinical signs.
• Oncological: Primary or metastatic tumor lesions can cause lower back pain. It’s a very rare cause of lower back pain.
• Infectious: Infection of the vertebrae, intervertebral discs, muscles, and various types of abscesses cause pain in the lower back.

As the Spine Health portal shows, the causes of sciatica are much more specific and the pathological “label” can be put on most of them. We’ll highlight the following:

• Lumbar disc herniation: This condition is responsible for 90% of sciatica symptoms. In this condition, part of an intervertebral disc moves towards the nerve root, presses on it, and produces neurological lesions of varying severity. It usually occurs when doing very demanding physical efforts, which is why it’s typical of athletes and people who work on the construction site.
• Lumbar canal stenosis: In this condition, there’s a narrowing of the spaces within the spine, which can put pressure on the nerves that run down the spine. Sometimes it’s asymptomatic, but in other cases, it presents with sciatica-like symptoms.
• Dyscarthrosis: Dyscarthrosis is the advanced wear of the disc that acts as a cushion between one vertebra and another. It’s one of the degenerative conditions that also manifests itself with lower back pain.
• Pregnancy: Sciatica can occur during pregnancy, especially when the fetus is so large that it presses on the sciatic nerve in any part of its path.

The differences between lumbago and sciatica on this front are more than clear. Although both conditions share etiology, lumbago is almost always mechanical and occurs due to a micro-injury at the muscular level. On the other hand, sciatica is usually caused by a lumbar disc herniation, a somewhat more serious condition. This requires medical attention in all cases.

4. Lower back pain is much more common than sciatica

As we’ve said in previous lines, lumbago affects up to 80% of the population in Western countries. During the 6-month time interval, the probability of suffering back pain in the adult population in countries such as Spain is 44.8%. In other words, almost everyone has lower back pain at some point (and generally more than once).

Lower back pain is more common in patients between the ages of 40 and 80, and the chances of experiencing it tend to increase with each decade of life. However, it’s not very clear if it affects more men or women.

On the other hand, sciatica shows somewhat more complex epidemiological patterns. We’ll summarize them in the following list:

1. The predominance of this clinical picture occurs in the fourth decade of life (40 years). Most cases before age 50 are due to a herniated disc.
2. The total incidence throughout life ranges from 10 to 40%.
3. The annual incidence is 1 to 5%.
4. It rarely occurs before the age of 20, except in cases where it’s due to direct trauma.
5. There’s a clear occupational predisposition, especially in those people who work moving objects, truck drivers, and machine operators.
6. There’s no association between the gender of patients and prevalence.

The differences between lower back pain and sciatica in the epidemiological setting are also quite evident. Lower back pain is much more common and universal, as it can also occur in the youth population (although it’s less common). Despite this, both conditions are one of the most common musculoskeletal disorders globally.

5. The symptoms are different in each condition

All the points cited lead us to this distinction. At the end of the day, what matters most to everyone is being able to distinguish both pictures from home to know when to go to the doctor. In any case, we recommend that you seek professional help for any symptoms of musculoskeletal disorder, as it’s always better to be safe than sorry.

The symptoms of lower back pain can be summarized in the following list:

• Difficulty moving. It can be severe enough that the patient is unable to get up.
• Pain is localized in the lumbar area and is generally dull and not irradiated.
• Muscle spasms, ranging from mild to severe.
• A localized area that’s painful on palpation.
• Dull tingling or burning in the lower back.

The main symptoms of sciatica are as follows:

• Pain that spreads from the lower part of the spine. This discomfort reaches the buttocks down the back of the leg.
• Sharp, stabbing pain, as if a needle were being thrust into the nerve from time to time. It’s usually described as an electric shock of varying intensity, although the experience differs in each patient.
• Discomfort that can reach the feet of the affected limb.
• Pain that increases when coughing, sneezing, or sitting in one position for a long time.

The differences on this front are also very clear. Lumbago usually affects the trunk bilaterally (only the lumbar region), is somewhat more diffuse, and manifests in a more diffuse way. On the other hand, sciatica affects one of the legs and the buttocks, causes a much more noticeable discomfort, and can extend to the feet, something that never occurs in typical lower back pain.

The differences between lumbago and sciatica: Different but complementary pictures

The differences between lumbago and sciatica are multiple, but not exclusive. A person can have pain in the lumbar area and, in turn, this pain can radiate to the leg, as the vertebrae and the structures of the sciatic nerve are very close to each other. For this reason, in many cases, both terms are used together, a condition known as lumbosciatica.

If you experience lower back pain or sciatica, complete rest is never an option as it will only make recovery even more difficult in the future. Go to the doctor and don’t neglect the problem. Although it’s surely nothing serious, it’s best to get help to treat the condition from home in the most effective way.