Herniated Disc S1-S2: Symptoms and Treatment

Herniated Disc S1-S2 Symptoms and Treatment

The most common levels of a herniated disc are L4-5 or L5-S1. The symptoms are characterized by sharp, burning, stabbing pain radiating down the leg from below the knee to the posterior or lateral side. The pain is usually superficial and localized and often associated with numbness and tingling. 

Motor deficits, decreased reflexes, and weakness can occur in more severe cases. The most common central disc herniation causes low back pain and saddle discomfort in the S1 or S2 distributions. The nerve roots of the cauda Equina may be compressed by a central herniated disc, which can cause difficult urination, incontinence or impotence. A medical history and physical exam may reveal bowel or bladder dysfunction. To prevent permanent impairment, it is important to immediately refer to a specialist.

The most difficult part of diagnosing patients suffering from a central herniated disc is often the distinction between low back strain or herniated. Low back strain can cause pain that is more severe when the patient is standing or twisting, while central disc herniation can make it worse when the patient is sitting. 

This is because of increased pressure on the annular fibers. It may be useful to ask the patient if their pain got worse while they were driving to the appointment or waiting in the waiting area. Sitting and bent postures increase pressure on the intervertebral disc, whereas standing or recumbent positions decrease it7. This is why herniated disc symptoms are worsened when the patient sits.

Anatomy and Structure of the L5-S1 Spinal Motion Section

These structures are common to this motion segment:

L5 and S1 vertebrae. There are many differences between the L5 and S1 vertebrae.

  • L5 is composed of a vertebral head in the front and an arch at the back. It has three bony protrusions, a prominent spinous process in its middle and two transverse processes along the sides. These protrusions are used as attachment points for ligaments.
  • The sacral base is also known as S1, or the upper and wider ends of the triangular-shaped Sacrum. The body of S1 is composed of the alae, a top-most portion with wings-shaped bones on each side. The median ridge, a bony prominence at the back of the S1 vertebra, is located at the bottom. On the left and right sides of this ridge, there are bony openings called foramina.
  • The lumbosacral facet joint lined with articular cartilage join L5 and S1.
  • L5-S1 intervertebral disc. Between the vertebral bodies L5 and S1, a disc is made from a gel-like material (nucleus pilosus), and is surrounded by an thick fibrous ring (“annulus fibrosus”). This disc protects the vertebrae from shock-absorbing and cushioning effects during spinal movements.
  • L5 spinal nerve. The L5 spinal nerve roots leave the spinal cord via small bony openings (intervertebral foramina), on the right and left sides of the spinal canal. These nerve roots combine with other nerves to form larger nerves that travel down the spine and down each leg.
  • The L5 dermatome, which is a part of the foot, knee, and leg, receives sensations from the L5 spinal neuron, is an area of skin.
  • An L5 myotome refers to a group or muscles that are controlled by the L5 spine nerve. It includes specific muscles in the legs and pelvis, which are responsible for foot and leg movements.
  • The L5-S1 motion section provides a bony enclosure to the cauda, which are nerves that run down from the spinal cord and other delicate structures.

Common signs of a herniated disc L5/S1

  • Back pain: This is the most common sign of a herniated disc L5/S1. Although it may be surprising, most people experience back pain after a herniated disc. It is possible to have a herniated disc 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 running down the back of your 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 disc L5/S1. The funny sensations are usually felt in the feet and toes. For some, it can even be more severe than the pain. The herniated disc presses against the nerve in the spine, preventing it from performing its task correctly. The sensation doesn’t feel normal because some signals aren’t getting through correctly.
  • 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 disc 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. The severity of the injury will determine 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 of the foot. The pain pattern of S1 is similar to “classic sciatica”, with the pain running down the back and sometimes into the toes. These are the most frequent L5-S1 symptoms of pain.

The most common symptoms of a herniated disc L5/S1 are:

  • Leg shaking/spasms: These spasms are often confused with sciatica. They cause muscle tension and spasms. 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.

Common Signs and Symptoms that Stem from L5-S1

Disc and vertebral pain starting at L5-S1 can be sudden after an injury, or gradual over time. A dull ache or sharp pain in the lower back is common. Discogenic pain can be worsened by sitting for too long, being in one position, repetitive lifting, and bending.

Radiculopathy symptoms and sciatica can be caused by inflammation or compression of the L5 or S1 spinal nerve roots.

  • Pain can be described as a shooting, sharp, or searing sensation in the buttocks, thigh and/or feet.
  • Numbness in the toes and/or foot
  • A weakness in the foot and/or leg muscles, and inability to lift the feet off the ground (foot drop).

Stabbing pains or aches can also be caused by a skin condition. These symptoms usually affect one leg at the time but can sometimes be felt on both.

Cauda Equina syndrome can occur at L5 to S1 because of injury to the cauda-equina nerves which descend from the spine. This is a medical emergency that can cause severe pain, weakness and numbness in the legs, genital area, and/or both legs. You may also experience loss of bladder and bowel control. This condition should be treated immediately to preserve leg function, and to restore bowel or bladder function.

Nonoperative Treatment

Low back pain and radiculopathy can be common causes of disability. However, most patients find relief regardless of treatment. One study15 found that 70% of patients suffering from radicular pain, whether it was L5 or S1, experienced a significant reduction in leg pain within 4 weeks. It is important to treat patients suffering from symptoms of a herniated disc within the first six weeks.

The family physician is often a teacher and offers advice about how to relieve the symptoms of a herniated disc. Low back pain is most often 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 prolonged bed rest is not associated with better outcomes16. It has been suggested that patients with herniated discs should be allowed to continue their normal activities while recovering.17 This 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 disc, flexion exercises should be delayed.

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Kevin Pauza, M.D.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Travis Foxx, M.D. - Premier Anesthesiology & Pain

Kevin Pauza, M.D. - Turtle Creek Surgery Center

Prior to attending Penn State University, Dr. Pauza earned his undergraduate degree from Lehigh University, and furthered his training with a Surgical and Medical Internship at Columbia University College of Physicians and Surgeons. He continued his specialty training at the University of Pennsylvania, followed by an Interventional Spine Fellowship. In addition to his research, philanthropic, and clinical endeavors, Dr. Pauza remains a motivated educator. He established a Spine Fellowship program and continues training physicians from around the world. He heads international committees responsible for establishing standards and educating surgical and non-surgical physicians.

After helping hundreds of patients who failed to experience relief after spine surgery, it became evident to Dr. Pauza that current methods needed to change. This motivated him to seek better ways to help patients, by thinking outside the box.

Dr. Pauza is the first physician in history to pursue FDA approval for using biologics to treat the spine. Millions of patients will benefit from his development of minimally invasive treatments for degenerative disc disease and other more common and serious disorders of the spine.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Brandon Tolman, D.O. - Nashville Spine Institute

Boris Terebuh, M.D. - Regenerative Spine & Joint Center

Boris Terebuh, MD specializes in providing personalized nonsurgical solutions for spine problems that interfere with the function patients desire and the independence they deserve. Dr. Terebuh completed his Physical Medicine & Rehabilitation residency training at The Ohio State University in 1997 and has been in solo practice in Ohio since 2001 because he is committed to providing accessible, individualized and attentive care to his patients. His regenerative approach to solving spine problems enhances the body’s natural ability to heal itself. His guiding principle is integrity – doing what is right for patients in a conscientious manner with the motivation of helping them become fully functional, independent and satisfied. Dr. Terebuh is a very unique Medical Doctor because he has earned seven Board Certifications in the field of musculoskeletal medicine and nonsurgical spine care. Boris Terebuh, MD is delighted to be a Discseel® provider because this revolutionary new technology aligns perfectly with his preferred regenerative treatment approach and patient care philosophy. Dr. Terebuh is also grateful to Discseel® developer, Kevin Pauza, MD, for all the years of diligent and meticulous research to create this innovative, paradigm-shifting intervention, which will certainly spare countless individuals the prospect of avoidable spine surgical procedures.

Thierry Bonnabesse, M.D. - Champlain Spine and Pain Management

Gregory Lutz, M.D. - Regenerative Sportscare Institute

Dr. Gregory Lutz is the Founder and Medical Director of the Regenerative SportsCare Institute (RSI). In addition, he currently serves as Physiatrist-In-Chief Emeritus at Hospital for Special Surgery (HSS) and a Professor of Clinical Rehabilitation Medicine at Weill Medical College of Cornell University. Dr. Lutz is one of the world’s leading experts in the field of regenerative interventional orthopedic medicine, appearing annually on Castle Connolly’s and New York Magazine’s “Top Doctors” lists.

Janet Pearl, M.D. - The Boston Stem Cell Center

Dr. Janet Pearl has been in practice since 1999 and is the Medical Director of The Boston Stem Cell Center. She is also the Medical Director of  Complete Spine and Pain Care  an interventional integrated Pain Management practice, both located in Framingham, Massachusetts. Dr. Pearl is Triple Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology and has over 20 years experience in doing these procedures.

Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Pain Management Fellowship program.

After graduating from Harvard College with an A.B. in Applied Mathematics with Economics, Dr. Pearl received a M.Sc. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine. She then received her M.D. from the Columbia College of Physicians and Surgeons, where she represented the Medical School as a senator in the Columbia University Senate.

Watch Dr Pearl give an introduction to The Boston Stem Cell Center

Dr. Pearl completed her internship in Internal Medicine at New England Deaconess Hospital, her residency in Anesthesiology at the Massachusetts General Hospital, and her fellowship in Pain Management at the Brigham and Women’s Hospital. Dr. Pearl was the first resident ever to serve on the Accreditation Council for Graduate Medical Education (ACGME)’s Residency Review Committee for Anesthesiology. She is a Joseph Collins Scholar and a Rotary Scholar and was awarded the AMA/Glaxo Welcome and AMA/Burroughs Welcome Resident Leadership Awards.

From 2004 to 2010, Dr. Pearl served on the University of Massachusetts Board of Trustees. While there she chaired the Committee on Science, Technology and Research, was a member of the Committee on Academic and Student Affairs and the Governance Committee and also served as Vice Chair of the Advancement Committee, and as a member of the Committee on Athletics.

Dr. Pearl is Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology with the American Board of Regenerative Medicine and the American Board of Anesthesiologists.

Memberships:

  • The American Pain Society;
  • The Massachusetts Medical Society;
  • The Massachusetts Society of Anesthesiologists;
  • The Massachusetts Society of Interventional Pain Physicians;
  • The American Society of Anesthesiologists;
  • The American Society of International Pain Physicians;
  • The American Institute of Ultrasound in Medicine; and,
  • The American Board of Regenerative Medicine.

PUBLIC SERVICE:

  • Member, Massachusetts Department of Industrial Accidents, Health Care Services Board 
  • Member of the Association of Harvard College Class Secretaries and Treasurers
  • Past Member of the Board of Directors of the Harvard Alumni Association
  • Former Member of the Board of Trustees University of Massachusetts. (10/2010 – 10/2014) 

Mark Reecer, M.D. - Fort Wayne Physical Medicine

Dr. Mark Reecer is board certified in Physical Medicine & Rehabilitation and Pain Management. He has over 20 years of work comp experience, and he routinely provides Independent Medical Examinations (IMEs) for the Indiana Workers’ Compensation Board. Dr. Reecer has lectured extensively and has authored multiple publications that promote his specialty and the use of treatment modalities to eliminate pain, improve function and avoid surgery.

Dmitry Buyanov, M.D. - IV Infusion Treatment Center

Dr. Buyanov is originally from Kiev, Ukraine. He received his training in Anesthesiology and his Interventional Pain Management Post-Doctoral at Penn State Medical Center, PA. Dr. Buyanov moved to San Antonio in 2003 at which time he was part of a multi-specialty group before he founded Premier Pain Consultants in 2004. His practice has over 5000 active patients in his practice. Dr. Buyanov treats his patients in a cost-effective manner although giving them the best care with interventional pain treatments/procedure to help each patient improve their quality of life. Dr. Buyanov strongly believes in an individualized and multidisciplinary approach to pain management, he believes in the Buddhist saying: “pain is inevitable but suffering is optional”. He works closely with the area internists, physical therapists, chiropractors, psychiatrists, neurologists, and spine surgeons to insure that each patient has the most optimal individualized treatment plan. Dr. Buyanov enjoys spending his spare time with his children.

Desmond Hussey, M.D. - NASA Neuroscience and Spine Associates. P.L

Dr. Hussey earned his undergraduate degree from Dartmouth College, and proceeded to earn his Medical Degree from The University of Miami School of Medicine. He then attended Northwestern University Internal Medicine Program, followed by a Neurology Residency Program at Emory University. Dr. Hussey continued his specialty training at John Hopkins University pain clinic. A member of The Spinal Injection Society and The American Academy of Neurology and Psychiatry.

Haley Burke, M.D. - Colorado Rehabilitation and Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Maxim Moradian, M.D. - Interventional Spine Care & Orthopedic Regenerative Experts

Dr. Moradian is triple-board certified in Physical Medicine and Rehabilitation (PM&R), Sports Medicine and Pain Management. Dr. Moradian’s clinical practice is devoted to the comprehensive care of spine, joint, muscle, tendon, ligament, and peripheral nerve disorders. He is proficient in performing advanced, minimally-invasive procedures under fluoroscopic and/or ultrasound guidance in the entire spine. Dr. Moradian performs electrodiagnostic testing (EMG/NCS) for the accurate diagnosis of muscle and/or nerve disorders. He has a special interest in regenerative medicine, sports concussions, neuromuscular ultrasound, medical education, and clinical research. His true passion is to treat his patients like his family and friends.

Wendi Lundquist, D.O. - Active Life Physical Medicine & Pain Center

Dr. Lundquist is the Medical Director and founder of Active Life Physical Medicine & Pain Center, Innovative Surgery Center, and Regena Spa. She is dual board certified in Physical Medicine and Rehabilitation along with Pain Management and a diplomat with the American Board of Pain Medicine. She completed her training at Loyola University in Chicago, Illinois in July of 2005. During her time there, she served as Chief Resident and was involved in several research projects. Prior to, she completed medical school at Midwestern University at the Arizona College of Osteopathic Medicine campus in Glendale, Arizona and internship at Doctors Hospital in Massillon, Ohio. She also has a Bachelor of Science in Biology and minor in Chemistry from the University of New Mexico in Albuquerque. She has a special interest in sports medicine, pain and spine. With 17 years experience, she has great enthusiasm towards regenerative medicine.

Yasuyuki Nonaka, M.D. - Nonaka Lumbago Clinic

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Matthias H. Wiederholz, M.D. - Performance Pain and Sports Medicine

Founding Partner, Triple Board Certified – Physical Medicine & Rehabilitation; Sports Medicine; Anti-Aging, Regenerative & Functional Medicine

Dr. Matthias H. Wiederholz is cofounder of Performance Spine & Sports Medicine, LLC. He is a fellowship-trained interventional pain physician whose clinical interests include: Interventional Pain Management, Sports Medicine, Musculoskeletal Medicine, Minimally-Invasive Spine Surgery, Non-Surgical Orthopedics, and Anti-Aging / Functional Medicine.

He received his specialty training in Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas where he served as chief resident. He completed fellowship training in Interventional Pain Management in Marietta, Georgia. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He also received advanced fellowship training through the American Academy of Anti-Aging Medicine and is board-certified in Anti-Aging, Regenerative & Functional Medicine.

Dr. Wiederholz performs a myriad of interventional pain procedures including, but not limited to the following: epidural steroid injections, facet joint injections, radiofrequency ablation, sacroiliac joint injections, discography, percutaneous disc decompression, epidural lysis of adhesions spinal cord stimulator implants, and minimally-invasive discectomies. Endoscopic spine surgery is a very unique and valuable tool in his armamentarium and makes Dr. Wiederholz one of the most specialized physicians in the field of Pain Medicine.

Dr. Wiederholz uses musculoskeletal ultrasound in the diagnosis of musculoskeletal injuries. He incorporates ultrasound for precise injection therapy including cortisone injections, prolotherapy, and PRP (platelet rich plasma). This technology is also utilized to perform the Tenex procedure, a percutaneous procedure for treating chronic tendon pain (tennis elbow, rotator cuff, plantar fasciitis, etc).

Dr. Wiederholz is the fellowship director for the sports and spine fellowship at Performance Spine & Sports Medicine. Dr. Wiederholz holds an affiliation with Capital Health System and JFK Johnson Rehabilitation Institute.

Being advanced fellowship trained in Anti-Aging, Regenerative & Functional Medicine means that Dr. Wiederholz has the most advanced training in Anti-Aging Medicine available. He is a leading expert in Bio-Identical Hormone Restoration and helps patients achieve wellness through nutrition, lifestyle, and hormone therapies.

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Michael Wolff, M.D. - Southwest Spine & Sports