Lower back nerve pain: causes, when it's sciatica, and treatment options

Not all back pain is the same. A sore, achy lower back after yard work feels different from a burning or electric pain that shoots into your buttock or down your leg. That second kind often points to an irritated nerve. Knowing the difference helps you get the right care sooner.

What lower back nerve pain feels like

Nerve pain from the lower spine tends to travel. People describe it as:

• Burning, sharp, shooting or electric pain
• Pain that runs from the low back or buttock down the back or side of the leg
• Numbness or tingling in the leg or foot
• Weakness, such as the foot catching on the ground when you walk
• Pain that is worse with sitting, standing, coughing or sneezing

Muscle-related back pain usually stays in the back and feels more like an ache or spasm. Nerve pain usually follows a path.

Is it sciatica?

Sciatica is the name for pain, weakness, numbness or tingling caused by pressure on or injury to the sciatic nerve, which starts in the lower back and runs down the back of each leg. MedlinePlus, from the U.S. National Library of Medicine, stresses that sciatica is a symptom of another problem, not a condition by itself. (MedlinePlus)

Doctors also use the term lumbar radiculopathy, which means irritation of a nerve root in the lower spine. Sciatica is one common form of it. Learn more on our sciatica and nerve pain page.

Common causes of lower back nerve pain

MedlinePlus lists these common causes of sciatica:

• Herniated or slipped disc. Disc material can press on a nearby nerve root.
• Spinal stenosis. Narrowing of the spinal canal can crowd nerves. Pain may get worse with walking or bending backward.
• Spondylolisthesis. One vertebra slips forward on another.
• Piriformis syndrome. A muscle deep in the buttock irritates the nerve.
• Pelvic injury or fracture.
• Tumors, which are less common but one reason persistent or unusual pain should be checked.

When lower back nerve pain needs urgent care

Some symptoms should not wait. Seek care right away for:

• Loss of control of bladder or bowels
• New numbness in the groin, buttocks or inner thighs
• Leg weakness that is getting worse
• Back pain with unexplained fever
• Back pain after a serious fall or blow
• Severe pain that keeps you from getting comfortable, or pain that wakes you at night

MedlinePlus also advises contacting a provider for pain that travels below the knee, unintended weight loss, or an episode that lasts longer than 4 weeks. Our guide on when back pain needs urgent evaluation covers this in more depth.

How lower back nerve pain is diagnosed

An evaluation starts with your history and a physical and neurological exam. Your clinician may check reflexes, strength, sensation and how your leg responds to a straight-leg raise. These findings help identify which nerve is involved, which matters for treatment.

According to MedlinePlus, tests are often not needed unless pain is severe or lasts a long time. When they are, they may include X-ray, MRI or other imaging of the spine.

Treatment options for lower back nerve pain

Treatment depends on the cause. MedlinePlus notes that most cases improve with conservative, non-surgical care, and that surgery is usually a last resort.

Conservative care. This often comes first:

• Over-the-counter pain relievers, if they are safe for you
• Ice for the first 48 to 72 hours, then heat
• Staying active rather than resting in bed
• Physical therapy and a guided exercise program to build core strength and spinal flexibility
• Avoiding heavy lifting and twisting in the early weeks

For more on building a plan that holds up, see mobility vs strength for back pain.

Interventional treatment. If conservative care isn't enough, options at SpineLUX Pain & Ortho include:

• Epidural steroid injections, which deliver medication near the irritated nerve to reduce inflammation
• Therapeutic nerve blocks, which target specific nerves involved in the pain

Surgical referral. When there is significant or progressive nerve compression, or symptoms don't respond to other care, a surgical opinion may be appropriate.

Lower back nerve pain relief: what to expect

MedlinePlus notes that sciatica often gets better on its own, but it is common for it to return. That is why finding the underlying cause matters more than chasing short-term relief. A plan that addresses the source, plus strength and movement work, gives you the best chance of fewer flare-ups.

Get evaluated in Irving or Houston

If you have back pain that travels into your leg, or numbness and tingling that won't settle, an evaluation can confirm the cause and the right next step. SpineLUX Pain & Ortho treats back and neck pain and nerve-related pain in Irving and Houston, Texas. Call 972-920-9111 to schedule.

This article is educational and does not replace a medical evaluation. Seek emergency care for loss of bladder or bowel control, rapidly worsening weakness or other severe symptoms.

Sources

1. MedlinePlus Medical Encyclopedia. Sciatica. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/000686.htm

Related: Sciatica & Nerve-Related Pain · Back & Neck Pain · When Back Pain Needs Urgent Evaluation · Mobility vs. Strength for Back Pain

This article is for general patient education and doesn't replace an individualized evaluation. Every treatment plan is different, and our physician team will walk through options, risks, and alternatives specific to your diagnosis before recommending a course of treatment.