A herniated disc is a common issue these days. One of the most common variations of this issue is known as Herniated Disc L5/S1. In most people, it occurs as a result of lifting extremely heavy items. If you are wondering is your spine suffering from the same problem, you should check out the symptoms, treatment among all other things related to this particular condition.
Understanding how the human spine works
Before we move to explaining the condition and treatment, it is important to explain how the human spine works. In the lack of a better word, it is a masterpiece. Spine is also known as the backbone and it allows us to sit, bend, move and twist. It consists of 33 vertebrae that are hollow inside and form a spinal canal. Through this canal, nerves and spinal cord pass.
Cervical vertebrae are at the top of the spine and they are labeled C1-C7. They are used when we turn or move our head. In the middle, we have thoracic vertebrae labeled T1-T12. There are obviously 12 of them. L1-L5 are the lumbar and they are located in the lower part of the spine. These vertebrae are under a lot of stress and they support most of your body and the rest of the spine. The sacrum is labeled S1-S5 and these do not move. The tailbone is the last part that is used for attaching pelvis muscles to it.
Between the vertebrae, spine has intervertebral discs. They act as cushions and they are flat with an interior filled with gel-like substance. That gel is held in place by an annulus or outer ring, which is flexible.
Spinal cord consists of 31 pair of nerves passing through the spine. The main purpose of these nerves is to conduct impulses between the brain and the muscles. Spine also has soft tissues such as ligaments that connect vertebrae. Tendons are used to connect muscles to the bone. Back muscles allow you to move and they act as support.
What is herniated disc L5/S1?
A herniated disc is a condition that occurs as a result of a damaged intervertebral disc. More accurately, the annulus, a shell that contains the gel-like substance is damaged and some of that gel will leak or cause the disc to expand. When that happens, disc increases in size and it will start pressing nerves, causing pain. Herniated Disc L5/S1 simply means that the disc between vertebrae L5 and S1 is damaged. This is the most common type. In general, the herniated disc usually occurs in the lower part of the spine. However, it may also occur in thoracic and cervical parts of the spine.
Herniated Disc L5/S1 is especially interesting because it is located in the part of the spine that is curved. The curvature changes and can be a forward curve (lumbar lordosis) or a backward curve (sacral kyphosis). In addition, L5-S1 is also responsible for transferring load from the upper parts of the spine to the legs and pelvis.
L5/S1 is known as a part of the spine that is under the most stress and also the most complex. It has distinctive anatomy which makes it a bit special. Sadly, this also means that this segment is most commonly affected by injuries which include degeneration and especially herniation.
Herniated Disc L5/S1 may occur at any given moment to any person. It isn’t considered as a dangerous condition but it must be treated. There are several complications that may occur. We will discuss those later. It is important to follow the guidelines of your doctor and to decrease the risk of this issue. Yes there are treatments and they are effective, but preventing a herniated disc is a much better decision and something all people should consider in modern times.
Diagnosing herniated disc L5/S1
Your doctor will have to diagnose the condition in order to give you proper treatment. This type of diagnosis is considered as more complicated, hence there are multiple steps a doctor will have to complete before giving you an accurate diagnosis.
First, he or she will start with questions. These should give the doctor a better idea about your problem and the pain. Questions such as type of pain you are experiencing, other medical conditions, your job, history of your health, and your family are essential, and usually, all Herniated Disc L5/S1 patients get all of these questions.
A physical exam is more complicated and there are 6 tests a doctor will perform. He may perform just a few or all of these, depending on your age and your initial symptoms. Anyway, you can expect tests as mentioned below.
- Neurological test- Here a doctor will test the sensations in your leg and foot. You may have to walk or even to stay on your toes for a short period of time. The goal of this particular test is to exclude foot drop (a condition in which muscles moving feet and ankles are weak) and also to check if numbness is present.
- Motion test- During this test you will need to bend forwards, backward, and to both sides. As the name suggests, this check is used to test the motion of your spine, which will be affected if you have Herniated Disc L5/S1!
- Leg raise- It is the simplest test. A patient will lie down and he will try to lift the leg which is in pain or numb. Once the pain starts, a patient will stop. If you were able to lift the leg between 30 and 70 degrees, it means you have a herniated disc. More precisely, this test is used to checking lumbar disc herniation specifically. But, this test can also reveal do you suffer from nerve root irritation. This happens if you lift the leg but pain isn’t present.
- Checking vital signs- The test is used to monitor your vital signs. If they are elevated, such as a higher pulse, it means that your body is in pain. This is a more generic test and various signs are tested.
- Gait- A doctor will keep an eye on your walking. If a patient walks too slow gait is abnormal, it may be an important sign for herniated disc.
- Lumbar spine test- The mission here is to check the skin on the lumbar part of the spine. A doctor may discover inflammation which is a symptom of herniated disc. The skin may become too sensitive to touch or may look abnormal.
If the condition is not severe, a doctor may prescribe you treatment right away. In other words, imaging tests are not needed. On the other side, getting at least one of the following tests is beneficial and can confirm doctor’s diagnose. Don’t forget that most doctors recommend that a person waits for 6 weeks in order to see if symptoms go away. Usually, they do.
Anyway, if imaging tests are required, your doctor will order one or more of the following tests.
- MRI – Magnetic resonance imaging is a type of scan that can be the most accurate and the most important when diagnosing a Herniated Disc L5/S1. A doctor may require this scan in order to see how much a disc is damaged and which nerves it presses, alongside other issues in the area. MRI is always used when surgical treatment is considered.
- CT – CT or computed tomography basically does the same thing as MRI but it is used when MRI isn’t recommended or allowed to be used on that patient due to some reason. The accuracy and the fact it is used before surgery still apply.
- X-rays – This test is rarely used to actually diagnose herniated disc. It is used to rule out other issues that may affect lumbar part of the back. For instance, it will be used to rule out tumors, a broken bone, infection or any abnormality that may cause the pain.
- CT myelogram – It is a mixture of CT and X-rays scanning. A doctor will inject a special dye in order to see better where the herniated disc is located and how it affects the nerves. Although safe, this is an invasive method and it is less-frequently used than any of the methods mentioned above.
- EMG – Electromyography is a different type of a test. It doesn’t involve scanning the bones or discs but rather nerve roots. This test can detect impacted nerves and help with diagnosis.
Causes for herniated Disc L5/S1
1. Lifting heavy objects
Causes for Herniated Disc L5/S1 are very simple to understand. The most common cause is lifting load that is too heavy. That’s why a doctor will ask you about your job and have you been lifting something in recent past. If you have a job of this kind or you exercise using weights, it is important to take precaution and to protect your spine or better said your vertebrae and discs in order to prevent this particular condition.
2. Age, wear, and tear of intervertebral discs
Another, also a common cause of herniated disc is age, wear, and tear. In simple terms, as we age, our intervertebral discs become less flexible, more damaged, and easier to damage as well. This directly affects annulus which can crack or ‘’leak’’ the gel located inside which causes herniated disc.
A direct cause for herniated Disc L5/S1 is pressure L5 and S1 vertebrae will inflict to the disc located in between. Under normal pressure, the disc is safe and sound. But, under extreme pressure, the disc will get damaged which causes the issue in question. We used herniated Disc L5/S1 as an example, but the case is the same with all other discs located in the spine. There is a condition known as bulging disk which may affect other discs in the spine. This is a less-severe condition than herniated disk. In that case scenario, the pressure of the bulging disc on the nerve is lower than with herniated disc.
Risks for herniated Disc L5/S1
1. Inactivity
Common risks for herniated Disc L5/S1 are inactivity and back injuries. Inactivity will make your muscles, especially back muscles weaker. They are unable to support the spine correctly and they can cause various problems with the vertebrae, including a herniated or bulging disc. In order to prevent that, you should walk and exercise on a regular basis. If you believe that your spine may get damaged or you may develop herniated disc, focus your exercising on lumbar part of the spine and back muscles in general.
2. Back injuries
Back injuries are another risk to worry about. These are common among people who have heavy-lifting related jobs that involve twisting the spine at the same time. Don’t forget that if you have a job of this kind, regular exercising may be the best preventive.
Symptoms of herniated disc L5/S1
Symptoms of herniated Disc L5/S1 are easy and hard to notice at the same time. The explanation lies in the fact not all people with this condition have pain. Some have minor symptoms that will go away after a short period. Others have extreme pain that is present all the time. Anyway, here are the most common symptoms of herniated Disc L5/S1:
1.Pain
Pain is the most common problem related to herniated Disc L5/S1 and the biggest issue that must be resolved. Not all people with this condition develop pain, but most do. Pain can occur immediately after an injury or can slowly progress and develop over a longer time. It is described as searing feeling, sharp and shooting pain located in lower back, toes, foot, leg, thigh, or buttocks. An interesting fact is that lower back pain is the least common of the bunch.
2. Weakness
Weakness occurs in the foot or a leg and it can cause additional problems. You may be unable to lift your foot and walk. The same symptom can be seen in other parts of the leg and can affect the entire leg as well. This is considered as more severe and it will require immediate treatment. There are all kinds of treatments for herniated Disc L5/S1 and we will cover all of those below.
3. Back muscle spasm
It is a rare symptom that might be presented in some cases. It is important to add that it can also be caused by other herniated disc and some other disorders related to the spine. Spasm means that your muscles will ‘’activate’’ themselves without a need and you will end up in pain and be unable to move.
4. Poor reflexes
It is another symptom that is common. Poor reflexes may occur in the ankle or a knee of the affected leg. Usually, it affects one leg only, but it can affect both in more severe situations. This can be a completely separate symptom or a combination of several others mentioned here.
5. Numbness
Numbness is another, also common symptom related to herniated Disc L5/S1. It will occur in the toes or foot only. This isn’t pain and doesn’t cause extreme problems for some patients. On the other side, we have patients who consider this even worse than actual pain.
6. Cauda equina syndrome
Cauda equina syndrome is rare but may occur in some patients. It is a severe issue that must be treated immediately. It happens as a result of damage or injury of the Cauda equina nerve. Additional symptoms you may notice are tingling or numbness in genital region, legs (one or both), groin, severe pain, numbness, and weakness in general. In more severe cases this issue can cause loss of bowel and bladder control. Treating it as soon as you notice the symptoms is mandatory to preserve the bowel and bladder control and also leg movement.
Herniated Disc L5/S1 may present itself with all of these symptoms, with just one or a couple of them. Pay close attention to the numbness and weakness of a foot or a leg. These are the first signs and symptoms that most commonly appear before others.
Herniated disc L5/S1 treatment
Herniated Disc L5/S1 disorder can be treated and cured. There are several methods commonly used today. A doctor will start with the least invasive treatment and move towards more complex and more complicated treatments if there is a need for that. Below, we will explore the treatments and help you determine which one is the best and most suitable for you.
1. Bed rest
Bed rest is the first and the most common treatment almost any doctor will recommend first. Don’t forget that you will need time to notice improvements. This may take up to a few days or even weeks. To recover completely, you may need up to 3 months. Bed rest should give you small improvements in the pain, numbness, and other symptoms after 24-48 hours. If the improvement is not seen, then you may want to try the next treatment here.
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2. Heat/ice treatment
Using heat or ice (not combined) is a highly recommended treatment for herniated Disc L5/S1. It is worth noting that this method will be effective if you start using it during the first 2 days since the pain occurred. After that period, it is less or not effective at all. You should start with an icepack applying to the affected area. This should decrease muscle spasm and ease the pain. If that doesn’t work, try the opposite thing. Try applying heating pads or take a long, warm bath. In general, both of these treatments should decrease inflammation and therefore decrease the pain.
3. Physical therapy
Physical therapy involves usage of special exercises that are developed for herniated Disc L5/S1 only. This is more a prevention than an actual treatment. But, some of those exercises are designed to be used when the condition is presented, while others should be used after the symptoms in order to decrease the risk from another occurrence.
4. Spinal manipulations
Spinal manipulation is simple and some of the first treatments a patient can try. It is performed by chiropractor. In some cases, this treatment will ease the pain and speed up the recovery. However, it doesn’t help all patients and many of them choose another treatment. It can be performed by an osteopath as well.
5. Acupuncture
You probably have heard of acupuncture, an ancient Chinese treatment for pain and many other health-related issues. It is based on tiny needles that are inserted into affected area. According to the U.S. Food and Drug Administration, acupuncture is an effective method in treating herniated Disc L5/S1. Once again, we can see many patients choosing another, more common and ‘’stronger’’ treatment rather than acupuncture. But, there are people who have been using this, alternative medicine treatment for various conditions and they were successful.
6. Cognitive behavior treatment Massage
Cognitive behavior therapy can be performed by experts in the real world or even online. The goal is to teach a patient how to manage the pain and change certain behaviors. Visualization of the pain alongside meditation are additional techniques used in this treatment. It is far from a common treatment, but the one that can help.
7. Massage
A massage, specially developed for sciatica or back pain in general can be helpful. These massages are designed to promote blood circulation, to help muscles relax, and also to force the body to release endorphins, natural painkillers. The effect can be the same as when using medications. Massage can be used for treating all kinds of back pain and other alignments.
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8. Medications
You can use over the counter medications to treat this condition. Usually, NSAIDs (non-steroidal anti-inflammatory drugs) are recommended. This is the first line of medications used. If the issue remains present, a person can opt for stronger medications that require prescription. Such medications are tramadol, corticosteroids, and opioids. These are stronger medications that must be taken with care and never without prescription. A mix of these medications can be used also.
9. Injections
Lumbar epidural steroid injections may be used when medications of the aforementioned treatments do not work. As you may believe, these injections are given to the spinal epidural space and the goal is to decrease nerve sensitivity. A patient will notice fewer pain signals hence pain will be decreased. Another purpose of these injections is to reduce inflammation. Lumbar epidural steroid injections are usually used for treating a bulging or herniated disc. They are not effective for treating pain caused by compression issues.
10. Radiofrequency ablation
Radiofrequency ablation is an interesting treatment that is considered as injection-based but it differs. A nerve that is affected will be heated with radiofrequency needle. This will create a lesion in the targeted area and prevent the nerve from sending pain signals to the brain. During this method, a doctor will use Fluoroscopic guidance and also a special dye in order to decrease the risk and increase the accuracy of the needle position.
11. More invasive, surgical treatments
When nothing mentioned above works and the pain is still present, a doctor will recommend surgery. There are several procedures of this kind. It is important to remember that surgery is only used if a person has been under pain for longer than 6 weeks and other treatments don’t have any effect. In a nutshell, surgery will be recommended if:
- A patient is under a lot of pain which makes completing daily tasks impossible.
- Bowel or bladder control is lost.
- Leg weakness and or numbness are advancing and becoming more pronounced.
- Medications are ineffective.
It is impossible to rank surgeries or to predict which one will be used for your particular condition. We have listed all of these below so you can get basic facts about each one. A doctor may recommend just one or multiple procedures in order to cure herniated Disc L5/S1.
12. Microdiscectomy
This is the most common, surgical procedure for herniated Disc L5/S1. In it, a doctor will remove a small portion of the herniated disc and therefore relieve the pressure it is causing on the nerve. In some patients, bone adjacent may be slightly removed due to the same reason.
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13. Lumbar interbody fusion
It is a very complex surgery that is used when nothing else is effective. In this procedure, a disc between L5 and S1 is completely removed. Pseudarthrosis may occur and it usually affects the S1 segment rather than L5. Once a disc is removed, a surgeon will combine the two vertebrae. In recent years, we saw recommendations for using interbody support. This is a device that keeps the two vertebrae in place and makes the procedure more effective and more successful. Without this support, the risk of failure is high and a patient may develop various other conditions in the future.
14. Laminectomy
This is a simpler procedure in which a surgeon will remove a very small part of lamina. This is a bone that is located behind the vertebrae and the purpose is to make more space for cauda equine. The procedure isn’t extremely invasive and it comes with a high level of success rate.
15. Facetectomy
This procedure involves facet joints. A doctor will trim them in order to achieve the same goal as seen in other procedures. The compression to the nerve roots should be decreased significantly after the procedure.
16. Foraminotomy
Intervertebral foramen or spinal nerve opening will be increased by trimming the bones surrounding it. Ideally, this will be used when the bone overgrowth is present. Once done, compression should be decreased hence the pain should be relieved.
Although it isn’t right to generalize, we can add that all of these procedures are not very dangerous and they carry little risk. Yes, some complications are possible but manageable.
Preventing herniated disc L5/S1
If you recall, we have discussed the causes of herniated Disc L5/S1 and the risks. But, here we will teach you how to prevent the condition and decrease the risk of getting this particular, herniated disc.
The first things you need to do are already known and we have mentioned them a couple of times in the content above. You need plenty of physical activity, you need to exercise and to avoid lifting a heavy load. Good posture is equally if not more important and it is something all people, especially those with a higher risk of developing a bulging or herniated disc should implement into life.
One, additional thing you will want to consider if you want to protect yourself is to keep optimal weight. Obese and overweight people are at a much higher risk of developing herniated disc, especially herniated Disc L5/S1 due to its position and the pressure it must withstand. Try to remember that this disc must withstand the pressure of the entire spine and most of the body. As such, it is under extreme levels of load almost all the time. Adding weight can be the worst thing to do and the most common reason for getting this condition.
Being obese or overweight paired with lifting heavy items and bad posture are the worst mixture you can imagine for developing herniated Disc L5/S1. All the ‘’right’’ ingredients are there so it is only a matter of time when you can start experiencing pain in your lower back.
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Living with herniated Disc L5/S1
A life where pain and other symptoms caused by herniated Disc L5/S1 are common isn’t high on quality. You should start with prevention first. Exercising and proper weight are something to include into your life. Avoid lifting heavy loads and stay active.
If you already have the condition, you should start with the treatment. Start with the simplest and move towards more advanced treatments. Once cured, herniated Disc L5/S1 is more likely to occur again. Using prevention steps explained is mandatory. Many patients were able to recover completely and don’t have any symptoms anymore. If you want to get the same perk, a severe change to your lifestyle is essential.
Conclusion
Herniated Disc L5/S1 is the most common type of condition that affects millions. It obviously occurs to the disc located between L5 and S1 when the outer layer of the disc is damaged and starts expanding, pressing the nerve. There are a lot of treatments and there are multiple ways you can use to protect yourself from this condition. Use all of them and if you notice any of the symptoms, visit a doctor immediately. Sooner you are diagnosed with herniated Disc L5/S1, easier treatment will be and also more successful.
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