Herniation can be caused by degeneration of the intervertebral disk from a combination of factors, especially at the L4-5 or L5-S1 levels. The extent and location of the herniation will determine whether there is pain, radiculopathy or other symptoms. A thorough history and physical exam, along with magnetic resonance imaging if needed, are necessary to distinguish a herniated disc from low back strain or other causes of similar symptoms. Patients usually recover within four weeks after onset of symptoms. Although many treatment options have been suggested to treat lumbar disc herniation (lumbar disc herniation), studies often show conflicting results. In the treatment of lumbar disc herniation, it is essential to screen for any serious pathology and monitor for the development of complications (such neurologic defects, cauda-equina syndrome, or refractory pain).
The intervertebral disk is responsible for attaching vertebral bodies together and providing flexibility, as well as absorbing and discharging the load on the spine. As we age, the disc experiences significant changes in its volume and shape, as well as biochemical composition and biomechanical characteristics. Annular degeneration, which leads to weakening the annulus fibrosus, is believed to cause lumbar disc herniations. The disc then becomes more susceptible to fissuring or tearing.
What is a Herniated Disc S5/S1?
A herniated disc L5/S1 refers to a problem at the lowest level of the spine’s spinal disc. Let’s look at the anatomy of your spine to better understand the situation. Once you are able to visualize the affected area of your body due to a herniated disk L5/S1, it will be easier to understand the reasons you have symptoms and how to fix them.
The Human Spine
24 vertebrae make up the human spine. These are strangely shaped bones that stack on top of one another. These vertebrae begin in your lower back and extend all the way up to your neck. The “cervical” vertebrae are the top 7 vertebrae of the spine. These are the vertebrae that make up your neck. These are called C1, C2, and C3, respectively, all the way to the base of your neck at C7. The 12 thoracic vertebrae make up your mid-back. These are T1-12. The five large lumbar vertebrae in your lower back make up your lower back. These are L1 through L5. L5 is the lowest vertebrae in the spine. Your sacrum is located below that. The sacrum, which is the oddly shaped bone connecting the right and left pelvis parts together, is your sacrum. The sacrum can be thought of as one bone. However, it has 4 sets or nerves that exit the Sacrum. These levels are called S1-S4. Your coccyx is located below your sacrum – it’s the little bone that makes your tail.
The Spinal Discs
A spinal disc is located between each vertebrae. It is made of tough cartilage and filled with fluid. If we were to refer to the disc between L1 & L2, then we would call it L1/L2. When we refer to disc L5/S1, it means the last disc in the spine between L5 (lowest vertebrae), and the sacrum. (S1). The discs are stronger than a donut but it is possible to think of them as a jam donut. They are made up of hard outer layers that are filled with fluid. They are extremely important. They allow the spine to move normally. They are essential for our ability to move, stand, and walk.
The Spinal Cord and Nerves
A long hollow passageway runs through the spine’s bones. The spinal cord runs through this passageway, from your brain to your back. It is the source of all nerves in the body. A tiny part of the spinal cord is split off at each level and becomes a nerve. This nerve runs from the spine to another part of the body. Human life is dependent on the nerves. They allow us to feel, move, talk, and digest food. The sciatic nerve is the longest nerve in our body. It starts at the base of the spine and continues down to the foot. It measures approximately an inch in diameter, and allows the legs normal function. The sciatic nerve is what allows you to move your legs without pain. Without it, your feet and legs would become completely numb.
What is the reason a herniated disc L5/S1 is so common?
Now we know that disc L5/S1 (or the lowest disc) is in the spine. It is located at the junction of the lower vertebrae with the sacrum. Our spines have unique curves at the top and middle. The areas with a dramatic curve are more likely to experience stress when we move and walk. The discs at the junction of two types of vertebrae (i.e. Normal movement can cause more stress to the cervical, thoracic (C7/T1), and lumbar and Sacrum (L5/S1) discs. This is a minor design flaw in how human spines are made. Unfortunately, we don’t have much control over it. The disc at L5/S1 lies at both the intersection of two levels and at the curve of the spine. It is at twice the risk than the other vertebrae, which is why L5/S1 herniated discs are so common.
What are the Symptoms for a Herniated Disc L5/S1
A herniated disk L5/S1 can cause a variety of symptoms. These symptoms can be frightening and alarming for anyone who has ever experienced them.
Common signs of a herniated disk L5/S1
- Back pain: This is the most common sign of a herniated disk L5/S1. Although it may be surprising, most people experience back pain after a herniated disk. It is possible to have a herniated disk and not feel any back pain. This shocked me at first. A herniated L5/S1 disc will cause a sharp, aching pain in the lower back. It can feel tender and akin to spasm.
- Sciatica: The most common cause is a herniated L5/S1 disc. Sciatica refers to the sensation of pain that runs down the back side of the leg. It can be very severe and shooting. My clients describe it as “being stabbed with a hot poker”.
- Pins and needles/Numbness: Sensory changes can occur in the foot and leg due to a herniated disk L5/S1. The funny sensations are usually felt in the feet and toes. For some, this can be more severe than the pain. The herniated disc presses against the nerve in the spine, preventing it from performing its task correctly. Sensation is disrupted and signals aren’t received properly.
- Weakness in the Legs: This symptom can be very alarming. You should see your doctor immediately if you experience weakness in either one or both of your legs. A herniated disk L5/S1 can cause weakness in the legs, particularly in the calf. This is a sign that you need to get it checked out as soon as possible.
What are the L5 – S1 Pain Symptoms?
A typical L5/S1 pain pattern is common for injuries at L5/S1. This pattern will vary depending on whether the L5 or S1 nerve roots are affected. The L5 pain pattern is characterized by pain that runs down the outside of the leg to the outer side of the shin, and then to the outside border of the foot. The pain pattern of S1 is similar to “classic sciatica”, with the pain running down the backside of the leg and often into the toes. These are the most frequent L5-S1 symptoms of pain.
The most common symptoms of a herniated disk L5/S1
- Leg shaking/spasms are often confused with sciatica. These spasms cause muscles to tighten up and then go into spasm. This symptom can be treated with a short course in muscle relaxants.
- Troubles with the Bladder or Bowel: This is a serious symptom that must be addressed as soon as possible by a doctor. The herniated disc at the L5/S1 causes the nerves that allow the bladder to function properly and the bowel to stop working. Incontinence can be described as inability to “go”, or feeling that your bladder/bowel are empty. You should consult your doctor immediately. You should contact your doctor immediately if you are unable to do so.
- Numbness in the private areas (or “Saddle”): This is another sign that requires immediate attention. This is another sign that the lower nerves have become compressed to the point they are unable to function properly. This could lead to a serious problem if it isn’t addressed quickly. You should go to the emergency department immediately.
What are the symptoms of L5-S1 disc bulge?
An L5-S1 disc bulge is the same as a L5-S1 herniated disk. However, the severity of symptoms does not necessarily reflect the severity.
What to Expect From a Herniated Disc S5/S1
In professional football, I was able to tell my manager with some accuracy how long a player would need to be out, depending on his injury. A mild ankle sprain, for example, would usually be healed in 3 weeks. However, a hamstring injury may take up to 6 weeks. However, it’s impossible to predict how long someone will be suffering from a herniated L5/S1 disc.
The rule of thumb is that the more healthy you are, the quicker you will improve. Age is also a factor. People under 40 tend to heal a lot faster than those over 40. It is hard to predict the time it takes for herniated discs to heal. Most people should feel much better 12 weeks after a herniated L5/S1 disc.
However, many don’t. Many people don’t realize this. Taking ACTION is the key to herniated disc recovery. If you are willing to make a change and work hard each day to improve your condition, it can often be significantly faster.
Time for L5-S1 Disc Bulge Recovery
Day 1 – Day 14
- Expect to feel a lot of discomfort. You’ll still need to be active, but you will also need rest. That is okay!
- It’s important to examine the underlying cause of the problem. Were you lifting or shifting with poor technique? This will need to be addressed later.
- How is your diet and how do you sleep? You’ll see improvement in your health and sleep quality if you get more sleep.
- To get through the worst, you may need to take a few painkillers.
- A doctor can help you if you have any concerns.
Day 14 – Day 28
- Although the pain might have subsided, you will likely feel stiffness in your lower back. This needs to be addressed immediately!
- This is where gentle movement is important – in your back, in your leg and going for a walk if possible.
- Keep your body hydrated. The discs won’t work or recover if you don’t. Get more water than you normally do.
Day 28 – Day 56
- Continue your rehabilitation, and keep moving as much as possible.
- You can start a stretching program to strengthen your legs. Click here for a simple stretching program that you can use to relieve sciatica pain.
- It’s now a good time for you to fix the problem at L5/S1 that caused your herniated disc. Was it weakness in the back? Was it a terrible technique? Did it have to do with your lifestyle? These are the things you need to address.
Day 56 – Day 91
- You should now be able to return to normality although you will still feel fragile.
- It’s important to slow down and not rush to get back to work. When you feel the pain, it is important to have someone there who can support you.
- It’s okay to have bad days. It’s not easy to recover from a difficult situation and there are very few setbacks.
- Continue to address the problem areas. You should strengthen your spine if it is weak. This is something you should not do without professional guidance. Get help from a professional, or invest in a system that has proven to work!
Etiology of Disc Degeneration
The intervertebral disk is divided into four layers: (1) the outer annulus fibrosus, which is made up of collagen fibril lamellae and dense collagen fibril; (2) the inner fibrocartilaginous annulus fibrosus; (3) the transition zone; (4) and the central nucleus. The disc’s frame is made up of collagen fibers in its annulus which provide strength and resistance to compression, and proteoglycans within the nucleus which provide stiffness.
There are four layers to the intervertebral disk: (1) the outer annulus fibrosus; (2) the fibrocartilaginous inside annulus fibrosus; (3) the transition zone, and (4) the center nucleus pulposus.
Many factors are thought to be involved in degenerative disc disease, including genetic factors as well as changes in collagen and hydration. The physical properties of discs are influenced by the water binding ability of the nucleus, which is widely accepted. The nucleus distributes the applied loads equally in a healthy disc. A decrease in the disc’s hydration can cause the cushioning effect to be less effective. This could result in an uneven distribution of the applied loads, which could lead to injury. Increases in collagen content and crystallinity are partly responsible for disc degeneration.
Distribution of load in intervertebral disk. (A) The nucleus evenly distributes the load in a healthy disc. (B) When the disc becomes degenerated, the nucleus begins to lose some of its cushioning abilities and the load is not distributed equally to the anuus. (C) The disc can become severely degenerated if the nucleus loses its ability to cushion the load. This can cause disc herniation.
Although genetic influences have been explored in spinal disorders such as scoliosis and spondylolisthesis, few studies have looked into the possibility of degenerative disc disease. One study found a strong family predisposition for discogenic low back pain. It suggested that both genetic and environmental factors are important in determining the cause of degenerative disc disease.
Image of the Herniated Disc
A decreased disc height is the most common finding in plain radiographs taken from patients with herniated disks. Radiographs have limited diagnostic value for herniated disc because degenerative changes are age-related and are equally present in asymptomatic and symptomatic persons.Neurodiagnostic imaging modalities reveal abnormalities in at least one third of asymptomatic patients.For this reason, computed tomography (CT) also has limited diagnostic value for herniated disc.
The gold standard modality for visualizing the herniated disc is magnetic resonance imaging (MRI), which has been reported to be as accurate as CT myelography in the diagnosis of thoracic and lumbar disc herniation.T1-weighted sagittal spin-echo images can confirm disc herniation; however, the size of herniation is underestimated because the low signal of the annulus merges with the low signal of the cerebrospinal fluid. For the diagnosis of degenerative disc disease, conventional T2 and T2-weighted fast spinning-echo images can be used. MRI can also show damage to the intervertebral disk, including annular tears or edema on the adjacent endplates. MRI, like CT scans can show bulging or degenerative discs in asymptomatic patients. Therefore, management decisions should be based upon the clinical findings and confirmed by diagnostic tests.
MRI has traditionally been used to acquire images in the axial or sagittal planes. Oblique images are now possible, providing better views of some anatomic structures than with traditional methods. Oblique images are perpendicular with the course of the neural foramen. To aid in detection of foraminal impingement, it has been suggested that oblique MRI could be used alongside the standard technique.
Low back pain and radiculopathy can be common causes of disability. However, most patients find relief regardless of treatment. A study of 208 patients suffering from radicular pain, either L5 or S1, found that 70% experienced a significant reduction in leg pain within 4 weeks. Patients with symptoms of a herniated disk should be treated symptomatically within the first six weeks.
The family physician is often called upon to educate patients about the best ways to relieve the symptoms of a herniated disk. Low back pain is most commonly treated with conservative treatment, which includes limited bed rest, exercise, and injections in select cases. The physician must determine the best treatment strategy and goals for each patient. The patient should be fully informed about the condition, including its likely natural history and possible treatment options.
Bed rest is a way to reduce both mechanical pain as well as intradiscal pressure while supine. It is not clear how long bed rest should be for herniated disc patients. However, it is recommended that bed rest last between two and seven days. Studies have shown that bed rest for more than two days does not result in a better outcome. Patients with herniated discs can continue to do their normal activities, which leads to a faster recovery. Excessive use of bed rest can lead to deconditioning, bone mineral loss, and economic loss.
It is not clear if aerobic exercise can be used to relieve radicular pain. Some believe strengthening the abdominal and back muscles can alleviate symptoms, reduce weight, and ease anxiety and depression. Patients and their families can easily learn massage and exercise techniques. After sufficient strength and pain relief have been achieved, extension and isometric exercises should be performed first. Then, flexion exercises can be allowed. Because flexion exercises place the most strain on the intervertebral disk, flexion exercises should be delayed.
One of the most effective exercise programs is the McKenzie program. The McKenzie exercise program is considered to be one of the most beneficial. It is crucial to determine the limitations of the patient and what the therapy goal is.
Trigger point injections may be able to provide prolonged relief for pain from localized areas, according to some physicians. Usually, a single injection of 1 percent lidocaine (Xylocaine), of approximately 1 to 2 mL is administered. Although the effectiveness of both phonophoresis and electricity over the injection site may offer additional relief, the benefits have not been proven. Patients with radiculopathy and lumbar disc herniation have been shown to benefit from epidural steroid injection therapy. However, other researchers have found limited benefits from steroid injections in patients suffering from radiculopathy.
Surgical Indications to Herniated Disc
Most patients with a herniated disk can be treated conservatively. However, there are some cases that require specialist referrals. All surgical decisions should be made based on clinical signs and the corroborating findings of diagnostic testing. Referrals are made for the following conditions: (1) cauda-equina syndrome; (2) progressive neurologic disorder; (3) profound neurologic deficit; (4) severe and persistent pain that is not responsive to conservative treatment.
Avoid Common Causes
Before back pain can be treated, it is important to identify the cause. The L5-S1 disc herniation is caused when you lift too much. Additional pressure is applied to the vertebrae when the load becomes too heavy. To reduce back pain, it is a good idea to stop lifting heavy objects.
Once the source of the pain has been determined, it is important to rest for the healing process. It is recommended that you get at least two days’ rest as it has been shown to accelerate the healing process.
Non-Steroidal Anti Inflammatory Drugs
Non-steroidal anti-inflammatory medications can be used to relieve pain and aid in healing. Sometimes, doctors may recommend ibuprofen or naproxen to patients they are treating. The type and frequency of anti-inflammatory medications prescribed will depend on the patient’s needs and circumstances.
Perform Healing Exercises
Exercise is another important part of the healing process, especially exercises that target the back. It is crucial that individuals are able to recognize which exercises can be beneficial and which may cause more damage to their discs before they begin any kind of routine to heal them.
Do exercises that stretch and flex the back
Stretching is easy for most people because it can be done simply by standing up and leaning forward.
Flexibility and Extensions
You can also do Flex and Extension exercises easily. These can be done while an individual is standing and then slowly bending forward.
Core Stabilization Exercises to a Herniated Disc
The core stabilization exercises are an important part of the healing process. These exercises help strengthen the abdominals as well as the lower back muscles. To perform these types of exercises, one will need to learn about weight resistance training. This type of disc herniation can be treated with a simple sit-up.
There are some things you can do to speed up the healing process for moderate disc herniation L5-S1. Many people begin their treatment by identifying the root cause of the problem and eliminating it from their daily lives.
There are several things you can do to speed up recovery once the problem has been identified. This includes getting enough rest, taking non-steroidal medications if necessary, and doing the right types healing exercises.
Herniated Disc L5 – S1 Exercises
When it comes to herniated disks and exercise, the most important thing is to remember that everyone is unique. A suitable exercise program for someone with a herniated L5/S1 disc will not work for someone else with the same problem. There are, however, some exercises that can be useful for people who have herniated discs.
This list is not intended to be a complete guideline. Some of the exercises may not be suitable for you. These are only suggestions of exercises that have been successful in relieving herniated discs L5/S1 for me.
Do not do any exercise that makes you feel worse. Start slowly and gently. Before you start any exercise program, consult your doctor. These exercises are provided for informational purposes only. They do not constitute a prescription. Before you start any exercise program, make sure to consult your healthcare provider.
#1 – Cobra Pose
- Start by lying face down on a flat surface such as a mat on the ground or a mattress.
- Your hands should be in line with your shoulders. Now, gently push your torso up and raise your arms off the ground.
- Keep your hips on the ground.
- You can only go so far as you feel comfortable. There is no benefit to going all the way.
- Gently lower your body to the starting position, and do this up to 10 times.
- These exercises can be done 3-4 times per day
This is who this is for:
This exercise is often the best for people with a herniated disk L5/S1. However, it doesn’t matter what causes your sciatica. You should only continue with this exercise if you feel comfortable doing this movement. For those who have difficulty bending forward, this exercise is a great place to begin.
This is why the L5-S1 pinched nerve exercise works
Because it involves lower back movement, this sciatica exercise encourages blood flow to the area to allow healing to occur. Researchers believe that this exercise causes the disc to bulge and “centralize” in the disc so it doesn’t pinch on any nerve roots.
#2 – Knee rolls
- Place a mat on your back or a mattress on your stomach.
- Halfway, bend your knees.
- Slowly, gently roll your knees over to one side.
- Return your knees to the starting position and then roll in the opposite direction.
- Continue for 30 seconds. Don’t rush, take your time and find a rhythm.
- If you are unable to do it every 2 hours, try to make time.
This is who this is for:
This sciatica exercise can be used to release tension in the lower back. This exercise is also great for restoring any rotation lost in the lower back after a herniated L5/S1 disc. This is why the L5-S1 pinched nerve exercise works. You can encourage a gentle, controlled rotation of your lower back. This will allow the muscles to relax a bit. This will provide relief from herniated disc pain.
#3 – McKenzie Side Bends
- Stand next to a wall. People prefer to do this exercise with the painful leg farther away from the wall. You can try both sides to find the one that is most comfortable.
- To support your elbow and forearm, you can use them to lean on the wall (1st photo).
- Slowly, gently let your hips “glide”, while your feet remain in the same place.
- Do not go further than is necessary. Then, return to your starting position.
- Do this 10 times. Take a break and then do 3 sets.
- This exercise may have helped you feel relief in your leg pain and back pain.
This is who this is for:
This exercise is great for disc problems. It’s a staple in the McKenzie treatment. This exercise can provide significant pain relief for sciatica and is quick to perform. This is why the L5-S1 pinched nerve exercise works. McKenzie’s approach claims that it works by encouraging disc material, called the “nucleus pulposus”, to re-centralize into its inner middle. Although scientific literature has not proven this to be true, I have witnessed this exercise offer relief for many. When performing this sciatica exercises, make sure you choose the most painful direction.
#4 – Standing Extension
- Stand up straight.
- Gently lean back. Do not go further than is necessary.
- You can extend your arms further if you feel comfortable (3rd photo).
- Slowly return slowly to the starting position
- You can do up to 10 repetitions every few hours. Your set should be cut short as soon as you feel any pain.
This is who this is for:
This is an excellent sciatica exercise to help a herniated L5/S1 disc. It works especially well for people who have trouble leaning forward and is a more user-friendly/convenient version of #1 on this list. It is slightly less effective than the Cobra pose, as people tend to focus more on their pelvic movement and not their spinal movements with this one. If you have spinal stenosis or arthritis of the lower back, this exercise should be avoided.
This is why the L5-S1 pinched nerve exercise works
The movement of the lower back is what makes this exercise similar to #1. It encourages blood flow to the area that has been injured to speed up disc healing. This may allow a herniated disc “centralize” to the inner disc, where it can’t pinch a nerve root.
The First Treatment for a Herniated Disk L5/S1 Part 1 – Lifestyle
Although diet is not often considered an important part of recovery from herniated disk L5/S1, it does play an important role. A diet that is optimized for recovery from herniated discs L5/S1 is crucial. This means that you should eat more anti-inflammatory foods. Pro-inflammatory foods must also be avoided.
People do well if they are active and healthy after a herniated L5/S1 disc. This means that you don’t have to take too much time from work. People should walk as much as possible within their comfort zone. It is best to stop when you feel pain, take a break and then go back to it. My client with a herniated disc (L5/S1) used to walk 100 yards up the road, then return to his house. For each day, that was all. Even those few hundred steps can make a big difference over several weeks. It is important to do it slowly and carefully. Don’t overdo it. My clients should stop if the pain gets worse. They should be able to gradually increase their activity each day.
It is vital to drink plenty of water. Any dehydration will only make the problem worse if you have L5/S1 herniated discs that compress nerves. Drinking 3-4 liters of fluids per day is crucial for success. This is a vital aspect of recovery.
When you have a herniated L5/S1 disc, it is important to get as much rest as possible. However, sciatica can make sleeping more difficult. A herniated disc L5/S1 recovery is only possible if you get enough sleep. This is where healing takes place. Without adequate sleep, it’s almost impossible to heal. If your pain is worse at night, you can make up for lost sleep by taking a nap. Some research has shown that a 20-minute nap can be as effective in restoring your health as two hours of additional sleep in the morning.
To speed up recovery, reduce discomfort
A herniated disc L5/S1 can be treated by avoiding further damage. It is a good rule of thumb to stop doing something that is making your pain worse.
Other Treatment Options for a Herniated Disc
A herniated disc is rarely treated with surgery. If you have exhausted all other options and still suffer, this procedure is for you. You should exhaust all other options first. Because you cannot reverse surgery, and often the results are not as impressive as they seem, it is important to exhaust all possible alternatives. Sometimes, surgery can cause someone to become worse. This is clearly devastating. Injections are another option that can provide pain relief along the sciatic nerve. These have not shown any significant results in my experience. They can sometimes be very effective.