Low Back Pain 101: How to Tell the Difference Between SI Joint Dysfunction, Muscle Strain, Lumbar Radiculopathy, and More

Your Low Back Hurts, But Do You Know Why?

If you’ve ever had to cancel a workout, miss a shift at work, or stop playing with your kids because of low back pain, you’re not alone. It’s one of the most common health complaints in the United States and a leading cause of missed workdays and doctor visits. But here’s what most people don’t realize: not all back pain is created equal, and treating every case the same way is a recipe for frustration.

At Peak Performance Sports Therapy in Blue Ash, Ohio, we regularly see clients who’ve been given a vague “low back pain” diagnosis. That label may be technically correct, but it doesn’t tell you anything meaningful about the source of your pain, what’s causing it, or how to treat it.

Is your pain coming from your sacroiliac joint? Is it a muscle strain? Is it a disc pressing on a nerve root? Could it be early-stage spinal arthritis? Each of these has a distinct pattern and requires a different approach.

With the right assessment and plan, most people can recover fully. But to get there, you need to know what you’re dealing with. This guide walks you through the most common causes of low back pain, how to identify them, and what works best for each condition.

1. Sacroiliac Joint (SIJ) Dysfunction

The sacroiliac joints connect your spine to your pelvis and play a key role in transferring force between your upper and lower body. When one side becomes irritated or unstable, it can lead to one-sided back pain that is often misdiagnosed or missed altogether.

Common symptoms:

Pain on one side of the lower back or buttock
Discomfort when standing up, climbing stairs, or shifting weight
Pain that usually stays above the knee
A dull, deep ache rather than sharp nerve pain

Clues that suggest SI joint involvement:

Pain relief when wearing an SI belt
Positive FABER or Gaenslen’s orthopedic tests
No significant findings on imaging like MRI or X-ray

Our treatment approach:

Manual therapy to correct pelvic alignment
Stability training for glutes and core
Myofascial release for tight surrounding muscles

2. Lumbar Muscle Strain

Muscle strains are a common cause of acute low back pain. They often result from improper lifting, sudden movements, or prolonged postures. Although painful, they are generally short-lived and respond well to conservative care.

Common symptoms:

Soreness in the lower back
Pain that worsens with movement, twisting, or lifting
No numbness, tingling, or leg symptoms
Morning stiffness that improves with activity

Clinical signs:

Local tenderness over lumbar muscles
No nerve involvement
Improvement typically within one to three weeks

Treatment includes:

Soft tissue therapy and massage
Mobility work and gentle strengthening
Postural and ergonomic coaching

3. Lumbar Radiculopathy (Nerve Root Compression)

This condition happens when a nerve root in the spine is irritated, often by a disc herniation. It is commonly known as sciatica and can cause pain to radiate from the back into the leg.

Key symptoms:

Sharp, shooting pain down one leg
Numbness, tingling, or burning in the leg or foot
Symptoms worsened by sitting, bending, or coughing
Weakness in the foot or leg

What we look for:

Positive Straight Leg Raise or Slump Test
Dermatomal patterns of sensory loss
MRI showing disc involvement or narrowing

Our strategy:

McKenzie-based spinal exercises
Nerve gliding drills
Manual therapy to reduce protective tension
Shockwave therapy for soft tissue irritation
Referral if red flags or neurological deficits appear

4. Lumbar Facet Osteoarthritis (OA)

Facet joints in the spine help guide and limit motion. As these joints age, they can develop arthritic changes, leading to inflammation and stiffness.

Symptoms of facet OA:

Morning stiffness that eases with light movement
Pain with prolonged standing or back extension
No leg symptoms unless stenosis is present
Usually seen in people over 50

Clinical indicators:

Joint tenderness during palpation
Reduced spinal extension
X-ray may show degeneration or joint space narrowing

How we treat it:

Gentle joint mobilizations
Core and spinal stabilization training
Aerobic activities like walking or swimming
Education on pacing and posture

Myths About Low Back Pain

Myth 1: You need an MRI to know what’s wrong
Imaging doesn’t always help. Many people have disc herniations or arthritis on scans and no symptoms at all. Clinical testing is often more informative.

Myth 2: Rest until it goes away
Too much rest can lead to stiffness and delayed healing. Movement is essential for recovery, especially when guided by a professional.

Myth 3: All back pain is treated the same
Each diagnosis has its own treatment strategy. SI joint dysfunction needs stability, disc issues need decompression, muscle strains need mobility and load, and arthritis needs control and endurance.

How We Diagnose and Treat Low Back Pain in Blue Ash, Ohio

At Peak Performance, we take the time to assess you properly. That means no cookie-cutter plans and no wasted sessions doing the wrong things.

Our diagnostic approach includes:

Postural and gait assessments
Functional movement screening
Special orthopedic tests
Palpation of soft tissue and joints
Strength and flexibility evaluation

Then we develop a custom plan that may include:

Manual therapy
Mobility drills
Strength training
Soft tissue work
Shockwave therapy when appropriate

We also coordinate care with physicians, orthopedic doctors, and chiropractors throughout the Blue Ash area when needed.

FAQs

How do I know what type of back pain I have?
A trained clinician can usually identify the cause through hands-on testing and a detailed history.

Can I have more than one issue at once?
Yes, many people do. For example, a disc issue can lead to muscle tightness or SI joint irritation. That’s why thorough assessment is essential.

Do I need a referral?
No. Ohio law allows direct access to physical therapy, so you can start treatment right away.

Ready to Fix Your Back Pain the Right Way?

If your back pain keeps coming back, isn’t improving, or has been misdiagnosed in the past, you don’t have to keep guessing. At Peak Performance Sports Therapy in Blue Ash, Ohio, we take a personalized approach to identify the true cause of your pain and build a plan that works.

Book your evaluation today and get on the path to long-term relief. And if this article helped clarify your symptoms, consider sharing it with a friend, teammate, or loved one who’s been stuck in the cycle of pain and frustration. Real recovery starts with the right diagnosis.