Dealing with a herniated disc in your lower back, especially at L4-L5 or L5-S1, can be challenging. However, with the right treatment approach, you can manage the symptoms and work toward relief.
Watch the video to learn how to treat a herniated disc at L4-L5 or L5-S1 without surgery, plus how to tell when surgery might be necessary.
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How Do You Treat a Herniated Disc at L4-L5 or L5-S1?
Herniated discs in the lower back occur most commonly at L4-L5 and L5-S1.
That's because:
- These discs bear the most weight of all spinal discs, and
- They're located at a transition point where the concave lumbar spine transitions into the convex sacrum.
While you should not rely solely on a YouTube video or blog post for treatment, this post will give you a general understanding of treatment options based on your symptoms.
Note: If you live in the St. Louis area and need treatment for herniated discs at L4-L5 or L5-S1, you can request an appointment here.
Symptoms of Herniated Discs (L4-L5 or L5-S1)
Symptoms of a herniated disc can vary widely.
Some people with a herniated disc may have no symptoms, while others may experience localized lower back pain, pain that radiates down the leg, or even changes in bowel or bladder function.
In many cases, herniated discs may be found on an MRI without causing any pain.
From: AJNR Am J Neuroradiol. 2015 Apr; 36(4): 811–816. doi: 10.3174/ajnr.A4173
Therefore, it’s essential to ensure the disc is truly the source of your pain and not a random coincidence.
When Back Surgery Might Be Necessary
In cases where there are significant changes in bowel or bladder function (cauda equina syndrome) or progressive muscle weakness in the leg, surgery might be necessary to prevent permanent nerve damage.
However, outside of these situations, most herniated disc issues can be treated conservatively.
How To Treat Herniated Discs Without Surgery
Conservative treatment is the first option for herniated discs, including physical therapy.
However, physical therapy treatments for herniated discs can vary based on your specific symptoms rather than just your MRI results.
If you only have localized lower back pain, core stabilization exercises may be needed as the discs are normally the main stabilizers of the spine
Staying active is also important for healing, as movement helps diffuse nutrients into the disc to aid recovery. Bed rest is generally not recommended.
Herniated Disc Exercises - Flexion vs. Extension
If your pain worsens when standing or walking, you may benefit from flexion (forward bending) exercises.
These include exercises such as bringing your chest toward your knees in sitting.
Or, doing double or single knee-to-chest exercises.
On the other hand, if your pain is worse when sitting or bending over, extension (backward bending) exercises may help.
These exercises include standing backward bending, or prone press-ups.
Stabilization Exercises for Herniated Discs at L4-L5 or L5-S1
Once your leg symptoms have centralized back into your lower back, it’s important to focus on spinal stabilization exercises.
Since your discs are the primary stabilizers of your spine, if you've injured a disc, it makes the spine slightly less stable.
Don't get too worried... it's not like your spine is going to give out on you or that you'll need a lumbar fusion surgery.
It's just a little more mobile (hypermobile) than a spine with all the discs fully intact.
By strengthening the stabilizing muscles that support the spine, you can help make up for that slight amount of hypermobility.
That way, you can reduce the chance of hurting your back again in the future.
Check out these posts to learn lumbar stabilization exercises:
10 Standing Core Stability Exercises For Seniors
The 7 Best Core Strengthening Exercises For Lower Back Pain
Need Treatment For A Herniated Disc at L4-L5 or L5-S1?
If you live in the St. Louis area and would like to find a long-lasting solution for your back pain, tap the button below to request an appointment with one of our specialist physical therapists.